150th Issue Articles

e-Governance in Indian Healthcare – Building a Stronger Nation

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Phanish Chandra
Co-founder and CEO, Docplexus

Like in most other economies, disruptive forces of digital technology are paving the path for better governance in India. The e-Governance movement holds potential to radically transform the way services are delivered to the populace. It promotes a collaborative approach to decision-making by allowing active participation of the common man in improving quality of public services through higher transparency and accountability.

The seeds of e-Governance in India were sown back in 1987 with the launch of national satellite-based computer network — NICNET. Since then, several e-Governance projects have been initiated at both Centre and State level. Rapid computerisation in the 90s coupled with widespread tele-connectivity and internet proliferation in recent times has provided an impetus to various e-governance initiatives in India.

Digital Health – A Crucial Area of e-Governance

If our country is to make great strides on the world stage, we must ensure that its populace enjoys abundant health. However the present public health machinery lies in dire straits, marred by multiple problems such as low budget, inaccessibility, high population density and lack of supportive infrastructure. India’s per capita spending on healthcare is less than 1 per cent.

Infrastructural growth in this sector severely lags behind its economic and sectorial growth. The ideal ratio of primary care centres is 74,150 per million people. However, the actual numbers are not even half of those. A majority of laboratories for testing drugs have inadequate facilities and are understaffed. Owing to the lack of access to basic healthcare services in remote regions, easily-curable diseases have turned into serious life-threatening conditions, creating an insurmountable burden of healthcare expenditure.

It is expected that e-Governance would resolve most of these problems. Effective application of ICT in health can ensure higher productivity through more efficient use of equipment, support staff and critical drugs; better quality of care; optimised drug supply and improved patient satisfaction. It can successfully tackle the malice of red-tapism, delays and chaos that currently prevail in large public hospitals across the country. In 2011, healthcare was added as a Mission Mode Project (MMP) in the National e-Governance Plan (NeGP). It was also included in the government’s ambitious ‘Digital India’ Programme launched in 2015.

e-Health – Fixing the Failings of Public Healthcare

Digitisation has the prowess to bring about radical improvements in every area of public health in India. Tele-health and online video consultations can take previously inaccessible expert care right to patients in the remotest regions. Telemedicine and tele-referrals can link primary, secondary and tertiary health facilities to disseminate latest medical knowledge to all. Data analytics can improve capacity planning and resource management in hospitals. The e-hospital initiative of the Digital India programme has come up with an online registration system that connects hospitals based on Aadhar. It facilitates services like online appointments, payments, access to diagnostic reports, information on blood availability, etc. With 6 hospitals on board and over 48,000 registrations, e-hospital is fully functional. The website is designed to enable real-time tracking of data and registrations. When all hospitals are interconnected, a master patient database would be created leading to a pan-India exchange of patient details. Local pharmacy databases would present an accurate picture of medicine stocks.

Digitisation is also empowering doctors for better information management, patient monitoring, medical education, and communication. Web-based libraries, online continuous medical education courses, KOL webinars, surgical videos, all equip the medical community to provide the best possible care. Online CME programmes and KOL interviews conducted by Docplexus, India’s largest online network of doctors, makes gaining latest medical knowledge highly convenient for its members.

Electronic Medical Records (EMRs) and Electronic Health records (EHRs) are leading to easy exchange of patient data between primary care centers, specialists and pharmacists. Data mining on EMRs can further discovery of new treatments. Computerised prescriptions are reducing chances of errors.

Challenges and Key Success Drivers

Successful e-Governance in health depends on India’s ability to overcome challenges and leverage opportunities. Following factors impact progress of e-Health:

Technological Innovations
Technological advances like mobile, cloud computing and IoT will prove conducive to more effective delivery of e-Health. With rapid adoption of smartphones (over 300 million users and counting) it won’t be long before we see a mobile in every hand. Last year, the government launched four mobile health services, namely, M-Cessation, Kilkari, TB Missed Call initiative and Mobile Academy. They are expected to take health services closer to those who need them the most.

Attitude of Medical Professionals
The extent of success of digital health initiatives is related to their acceptance by doctors and medical staff. Currently, there is little awareness about the importance of electronic management of health data. Very few hospitals maintain EMRs as doctors consider it cumbersome to update the data in the system. The existing resistance to usage of technology can be dissipated through communication and training. Medical staff needs to be convinced that technology will assist and not replace them. Computer-aided teaching techniques should be adopted for medical and nursing courses.

Public Awareness
Experts cite lack of awareness and understanding of use of ICT in healthcare as a key hurdle in widespread adoption of e-health services. Despite online availability of diagnostic reports in certain hospitals, most people continue to collect the reports from the hospitals in person. Poor literacy levels, lack of regionally-relevant content, and low availability of appropriate access devices are some factors that hinder success of e-health initiatives.

Interoperability, portability, integration
e-health requires joint effort of various government departments such as Department of Electronics and IT (DeitY), Department of Telecommunications (DoT) and Law, among others. It is necessary to put in place systems and interoperable standards that allow seamless integration across departments, eliminating data duplication.

Infrastructure, Internet and Data Speed
Only when required infrastructure is in place will healthcare technology be accessible to all. The government’s plan to connect 250,000 villages with the National Optical Fibre Network (NOFN) by 2016 has grossly failed to meet the deadline, with only 1 per cent of villages having been connected. Last-mile connectivity will continue to be a challenge in forthcoming years owing to its unaffordability for most Indians. Internet penetration in India is close to 28 per cent, leaving a majority of the populace outside the reach of e-health facilities.

Affordability of broadband or mobile for low income group remains a question. While 48 per cent of those who do access the internet are still on narrowband, almost half of total mobile users rely on 2G connections.

Participation of Private Sector
The private sector has a key role to play in the success of e-Governance in healthcare Earlier this year, Glocal Healthcare announced its alliance with CSC e-Governance Services India Ltd., the nodal autonomous agency of Ministry of IT, through which it is offering video consultation services to 84 crore people in remote areas.

HP is working on automating 19 public hospitals and 14 medical colleges in Maharashtra. CMC is providing handheld mobile computing devices to Primary Health Centers. Docplexus recently tied up with the National Center for Disease Control (NCDC) and Indian Public Health Agency (IPHA) as their knowledge partners. Through this collaboration, NCDC and IPHA have connected to a community of over 2,25,000 doctors from 92 specialties and 1,500 cities for furthering their public health agenda. Participation of private players is crucial to provide last mile access, location specific access and cloud-based services relating to delivery of remote health.

Privacy, Security, Ethics
Rising instances of cybercrime call for application of the best security protocols. A privacy policy needs to be formulated so that sensitive health information of a billion citizens is not misused. Medical informatics, a new frontier of bio-medicine, is closely linked to tele-health. Although still at a nascent stage in the country, it is predicted to cover all areas of healthcare in the coming years. This brings forth the need for effective handling of ethical and legal issues that could arise in this area.

While e-Governance can prove to be a panacea for most problems grappling public health in India, its effective implementation requires determination, removal of major roadblocks and collaborative action on part of government, medical establishments, corporate ICT players and non-profit organisations.

Authored by: Phanish Chandra, Co-founder and CEO, Docplexus

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