ASSIGNMENT ON

DIGITIZATION OF
PUBLIC HEALTH
DEPARTMENT

SUBMITTED TO, SUBMITTED BY,

DR. UMASHANKAR LAVEENA NORONHA

PRINCIPAL MPH II SEM

PSPH PSPH

BANGALORE. SUBMITTED ON BANGALORE.

30/06/18
 Introduction:

Digitization has the potential to affect every aspect of care delivery and operations, enabling smarter choices
and better utilization of time and resources and allowing people to spend more time on patient interaction at
the point of care.1

Healthcare digitization will invariably improve the care delivery process potentially benefiting providers,
stakeholders, and patients with greater use of information and digital technologies. This will help in
achieving a reduction in clinical negligence and litigation with better utilization of health information
technologies.

The activities/function/program/ that I would like to suggest to digitize a public health department
are as follows:

A. ONLINE SERVICES:

1. Telemedicine:

Today in India 80% of people live in rural areas that do not have easy access to primary care or specialist
services. Based on digital technologies, they can benefit from faster access to care, more convenient
management of conditions, and improved access to experts.

Tele health also benefits medical providers. At a time when fewer doctors are servicing more patients,
video appointments provide a time-effective option for helping those who are managing a known condition,
for filtering some who might need to see a specialist, and for identifying those who should go immediately
to the emergency room. Remote appointments are also more cost effective, minimizing impact on medical
staff and services.

Five digital imperatives to incorporate telemedicine:

 Making Your Business Interoperable

The foundation of the healthcare digital transformation is an interoperable environment that enables the
secure sharing of information across all levels.

When tactical and overall strategic goals, data, priorities, processes, and tools do not align with those of
other departments, there is increased risk of lost business, lower operational excellence and productivity,
increased exposure to regulatory and compliance requirements, and higher operating and capital
expenses. By knocking down silos and bridging the gap between business and IT, organizations can drive
real-time agility and deliver new levels of business and operational efficiency as they connect everything,
embrace analytics, and secure their technology and operations. For example, the Cisco® Converged
Clinical Workflow family of solutions helps patients, clinicians, administrators, and families use data,
voice, and video to collaborate more effectively to make better decisions, increase teamwork, boost
productivity, and reduce costs.
  Securing Data and Systems

To address new and continuing security challenges, digital transformation extends data and physical
security across the system to protect information and safeguard patients and to help organizations manage
financial, legal safety, quality, and compliance risk

 Empowering a More Efficient Workforce

To make healthcare providers as productive as possible, therefore, many organizations are focusing on
how new capabilities can help employees work better and faster, focusing their attention on patients
instead of administrative tasks. However, too often companies try to implement new solutions without
allowing time for workers to learn how they can benefit from a different approach. As the company
embarks upon its transformation journey, its culture needs to

2. National health portal:

This is to create awareness amongst the citizens about health, government programmes and services in
health sector, national health portal (NHP) provides information to citizens and stake holders in different
languages (currently in hindi English tamil gujrati Bengali and Punjabi.) a voice portal is also available on
the toll free number 18001801104 and mobile app are also available. Features that are included in this are
healt programs, about diseases, insurance details, healthy lifestyle, road safety tips.

3. E-Hospital:
e-Hospital@NIC a hospital management system is a workflow based ICT solution for hospitals specifically
meant for the hospitals of government sectors. This is a generic software which covers a major functional
areas like patient care, lab services, work flow based document information exchange, human resource and
medical records management of a hospital.
 Modules of e-hospital: patient registration, emergency registration, clinics, billing and accounts, path lab,
radiology/imaging, PACS interface, blood bank management, IPD, OT management, pharmacy, EMR, birth
and death registration, care provision, stores and inventory.

4. Online Registration System (ORS):

In order to improve ease of services for citizens, Online Registration System (ORS) launched in July 2015
provides services to citizens for taking online registration & appointment, payment of fees, online viewing
diagnostic reports, enquiring availability of blood online etc. in various public hospitals.

5. `Mera Aspataal’ (Patient Feedback) Application

To empower citizens to participate in improvement of healthcare service delivery by providing feedback on
service quality, facilities etc. at hospitals and ultimately help establish patient driven, responsive and
accountable healthcare system, this application has been launched which is an IT based feedback system to
collect information on patients’ level of satisfaction using a multi-channel approach viz. SMS, Outbound
Dialing, Web Portal, and Mobile App. It is expected to help the government to take appropriate decisions
for enhancing the quality of healthcare delivery across public facilities which will improve the patient’s
experience. The patient will be able to receive an effective and appropriate care.

6. Central Drugs Standards Control Organisation, “SUGAM” :

To provide a “single window” for multiple stakeholders (Pharma Industry, Regulators, Citizens) involved in
the processes ofCentral Drugs Standards Control Organisation, “SUGAM”enables online submission of
applications, their tracking, processing & grant of approvals online mainly for drugs, clinical trials, ethics
committee, medical devices, vaccines and cosmetics.

B. SERVICE DELIVERY AND TRACKING:

1. Mother and Child Tracking System (MCTS) / Reproductive Child Health (RCH) application
It is an individual-based tracking system implemented across all the States & UTs to facilitate timely
delivery of antenatal and postnatal care services and immunization to children with an objective of
improving IMR, MMR, & morbidity; providing alerts to health service providers about the services due list
and service delivery gaps; appropriate health promotion messages to beneficiaries. Currently over 12 crore
pregnant women and around 11 crore children have been registered on MCTS / RCH portal since inception

2. TB Patient Monitoring System “Nikshay”:

For tracking of individuals for treatment-adherence has been implemented across all States for monitoring
of TB patients. Also a Missed Call Centre facility with Toll Free No: 1800-11-6666 for reaching to
unreached TB patients is available, for counselling and treatment support. Approximately 80 lakh patients
have been registered on Nikshay.

3. Tobacco cessation program:

Is is a mobile-based interventional initiative for counselling and helping people to quit tobacco, by giving a
missed call to 011-22901701. Currently over 20 lakhs total missed calls have been captured and around 15
lakhs users are registered for this programme.

C. PROCESS AUTOMATION
1. Hospital information system:
HIS is being implemented in hospitals for automation of hospital processes to achieve better efficiency and
service delivery in Public Health facilities upto CHC level. Targeted impact includes facilitation in hospital
workflow management leading to better delivery of services to patients and improvement in efficiency of
processes at hospitals. Key implementation milestones include:

a) e-Hospital developed by NIC has been implemented on cloud platform in over 100 hospitals as on date
and more than 50 hospitals are on standalone platform
b) e-Sushrut application of C-DAC Noida has been Functional in Rajasthan (State-wide: 80 facilities) &
15 hospitals in other states

2. ANM on Line (ANMOL):

A tablet based application for Integrated RCH Register which allows ANMs to enter and update data for
beneficiaries of their jurisdiction has been piloted in the State of Andhra Pradesh and currently around
15,000 ANMs are working on ANMOL in Andhra Pradesh and pilot districts of MP & Telangana

3. Drugs and Vaccines Distribution Management System (DVDMS) (‘eAushidhi’)

It deals with purchase, inventory management and distribution of various drugs, sutures and surgical items
to various District Drug Warehouses of State / UT, District Hospitals (DH), their sub stores at CHC, PHC
etc by automating the workflow of procurement, supply chain, quality control and finance department in
State / UT level. DVDMS has been implemented so far in 9 States/UTs – Andhra Pradesh, Gujarat, Jammu
& Kashmir, Madhya Pradesh, Maharashtra, Odisha, Punjab, Rajasthan &Telangana and is in process in 8
States/UTs- UP, UK, Bihar, HP, Manipur, Jharkhand, Meghalaya & Chhattisgarh. DVDMS has also been
implemented in Central Medical Services Society (CMSS) - a Central Procurement Agency under
Department of Health & Family Welfare and is under implementation TB Division & Family Planning
Division of MoHFW. States like Tamil Nadu, Tripura, Haryana, Karnataka, Kerala, Delhi and West Bengal
have implemented IT based supply chain management systems other than DVDMS, but which have similar
features.

4. eRakt Kosh:
eRakt Kosh has been launched which is a comprehensive, efficient and total quality management approach
with the help of online systems and is being rolled out for all the licensed blood banks in public and private
health facilities in States / UTs. eRakt Kosh is online in 7 Blood Bank in States/UTs of Delhi, Madhya
Pradesh, Uttarakhand and Uttar Pradesh. Around 124 Blood Banks are registered on e-RaktKosh Portal for
Blood Stock Updation. 2 blood banks in Uttrakhand, 1 in UP and 1 in West Bengal are in process of using
the application
management information system and surveillance

5. Health Management Information System (HMIS) :

HMIS is a web based portal for monitoring the programmes under National Health Mission (NHM).

For monthly service delivery data reporting from public health facilities to improve program monitoring and
management. Approximately 2 lakhs Health facilities are regularly reporting on HMIS Portal. It is
integrated with GIS and available in public domain.

6. Central dashboard:
Central Dashboard is being developed for monitoring of key indicators related to different health
programmes of the Ministry.
Dashboard system collects data from existing public health information systems (i.e. HMIS, IDSP, MCTS,
Nikshay, etc) The Dashboard system will also help in analysing/ measuring progress on newer healthcare
initiatives of MoHFW, Government of India

7. Integrated Disease Surveillance Programme (IDSP):

Online portal for data entry, reports, data analysis, training modules, on which ~90% districts report weekly
surveillance data through portal. There is also a 24x7 call centre for disease alerts on a toll free number; for
verification and initiating appropriate action

How will it benefit the department and the government

In the evolving digital health landscape, the digitization of health information and well integrated health
information technology (IT) systems will be extremely powerful in reducing overall healthcare spending
while assisting providers in the process of quality care delivery. The digitization of NHS health system can
truly transform the delivery of care by means of unique offerings around evidence based practices, health
analytics, and improved patient stratification. Healthcare information system adoption is high in the NHS;
about 82% of them have clinical information system (CIS) in place including patient administration system,
scheduling, billing, and payroll management, while electronic health records (EHR) adoption has always
been phenomenally high in the NHS. Integrated digital health platforms that offer choice and agility,
strengthens the impact of digital clinical engagements among providers and patients allowing health
professionals to spend more time with patients. Digitized health information can pave the way for
breakthrough research that was never possible when patients' data were hand-written and stacked in back
offices of hospitals. Furthermore, as the NHS streamlines digitization efforts and becomes more integrated
by offering various health and care services, it will become stronger and achieve better health and financial
outcomes.

With the digitization in full effect, process improvements are expected to be seen in health data management
such as archival/retrieval of patient information, electronic referrals, high priority electronic drug file to
electronic prescribing. For clinicians and nurses, fully digitized health system can present a whole new way
 of digital patient interactions, electronic observations, and handovers. Mobile devices and tablet computers
in the hands of nurses can enhance mobility while caring for patients and moving between wards. Mobile
health or mHealth technology can act as a digital gateway enabler for integrating patient generated data into
electronic records. Bespoke cross-platform ICT tools can be implemented to harness the patient generated
health data from connected devices and health wearables.

By creating NHS based eHealth strategies, digital information can be applied to learn more about population
health, enhance preventive care, drive clinical decision making, and collaborative reporting. Digitization can
enable shared learning across NHS, avoiding unnecessary duplications and human errors in health data
processing.

The single most important factor that changes the way healthcare information is managed is the mobility of
data between various networks, databases, and stakeholders without compromising on security.

 Interoperability Challenges: Complexity experienced while sharing information between electronic records
between providers and healthcare organizations.
 Implementation Cost: NHS being a massive health system, with over 37 community providers, 154 acute
trusts, 209 CCGs with more than 8,000 GPs, implementation is of a biggest concern to achieve
standardization.
 Availability of Funds: Ensuring adequate funding is in place and available to service providers must be
prioritized to enable smooth implementation across the health system.
 Data Governance: A fundamental challenge is the on-going concerns around patient data security and
information governance. Mobile devices with sensitive data must be capable of encryption in order to
overcome the data breaches.

Conclusion
Healthcare digitization followed by eHealth technologies, expertly implemented across care
continuum to support essential changes in how healthcare system works, can achieve what often
feels near impossible in the NHS. Equipping healthcare professionals and staff with digital
technologies such as smartphones, tablets, and mobile clinical assistants that have remote access to
patient records can reduce the likelihood of medication errors, avoid documentation concerns, and
free from data entry commitments allowing more time to spend with patients. The responsibility of
implementing digital health technologies is now on the stakeholders of the health systems to
collaborate and build the sustainable quality healthcare delivery model.

Reference:
1. Supten Sarbhadhikari, how can digital health be implemented as envisaged in the
national health policy 2017,health care IT experts, accessed from:
https://blog.hcitexpert.com/2018/04/how-can-digital-health-be-implemented-in-
NHP2017-Prof-Supten-Sarbadhikari.html?m=1 , accessed on: 25/06/18
2. Departments of Health and Family Welfare, e-Health & Telemedicine, accessed from:
https://mohfw.gov.in/about-us/departments/departments-health-and-family-welfare/e-
Health%20%26%20Telemedicine accessed on: 25/06/18