Public Health IT study report

1. CONFIDENTIAL AND PROPRIETARY TO THE PARTIES IN DISCUSSION.
Contact: Dr Pankaj Gupta
Partner, Taurus Glocal Consulting
Independent Consultant, NHSRC.
Member ICT Sub-Group of Healthcare SIC under PMO GOI.
Dr_pankajgupta@yahoo.com
drgupta@taurusglocal.com
Website: www.taurusglocal.com
Blog: http://www.healthcareitstrategy.blogspot.com/
LinkedIn: http://www.linkedin.com/in/drpankajgupta

2. • India has been very ingenious in
finding workarounds but we have lost it
along the way to modernization
• Organizations not designed ‘ground
up’ for innovation will not be creative.
Innovation can be extraordinarily
disruptive.
• Culture of innovation has to be
nurtured in the country.
• Must work with all stakeholders to
select and deploy innovative
improvements that measurably
improve service quality and provides
truly ‘out of the box’ thinking to the
country.
2010-2020 DECLARED AS DECADE OF INNOVATION
I N N O V A T I O N I S A C U L T U R E
N O T A S T R A T E G Y

3. NATIONAL INNOVATION COUNCIL [NINC] CREATED
TO PROMOTE INNOVATION IN THE COUNTRY
Transformative
Leadership
Next
Practices
Process
Innovation
Incremental
Improvements
Existing
Operational
ModelsObsolete
Resilience
Business as Usual
Short Term Gains Long Term Success

4. ICT SUBGROUP OF HEALTH SECTOR INNOVATION
COUNCIL IS PART OF NINC

5. Next Practices
Where we want to be
Where we are today
Quantum Leap in
Planning Paradigm
Work backwards from where we want to
be, to develop the Execution Plan to get
there, not the reverse
NEXT PRACTICES - INNOVATION

6. o Process:
o Consultation with program officers
o Review of the literature on Public
Health ICT
o Study of innovations in Health care
ICT
o Functional Specifications of
Public Health IT Systems
o Study of IT systems for Tele-
medicine
o Study of Hospital Information
Systems
o Mandate:
o To document various ICT
innovations in healthcare
o To identify drivers of innovation
o To understand failures &
successes and reasons
associated
o Prepare & promote sustainable
‘eco system’ for ICT innovations
in healthcare
CURRENT INNOVATION IN HEALTH ICT
Systems Studied
NRHM-RCH National Program Specific innovations
National HMIS Web Portal NACO- Strategic Information Management System
DHIS 2.0 Integrated Disease Surveillance Project (IDSP)
MCTS- Tracking System National Malaria Control Program -NAMMIS
State Specific innovations Other Innovations
Gujarat- eMAMTA, Tripura Tele-ophthalmology application
Tamil Nadu- State HMIS (TCS) Kerala Tele-oncology application
Andhra Pradesh – Historical HMIS Development

7. ALL PUBLIC HEALTH IT SYSTEMS ARE IN SILOS
Nutrition
Block
Facility
MCTS –
Reprod.
& Child
Health
System
at
National
Level
NACO
National
Disease
Program
Hospital
Informati
on
Systems,
EMR
State
Health
Program
s e.g.
EMRI,
eMamta,
HMIS,
DHIS
Birth &
Deaths
Private
Sector
MOHFW
District
Admin
State HQ
Directorates e.g.
Malaria, IDSP, NACO
IDSP
National
Disease
Program
Malaria
National
Disease
Program
RNTCP
National
Disease
Program
Web
portal –
Reprod.
& Child
Health
System
at
National
Level
o Programs/ directorates/ states have their own IT solutions for program reporting needs.
o Silos - All systems functioning in silos and doesn’t help in integrated decision making.
o Standards lacking – Architecture, I/O Data standards, Disease and Service codes,
Interoperability standards.
o Design issues- Developed as Application for single purpose not as products
o Capacity building - change management is limited
o Process transformation - business process reengineering not done

8. PROPOSED NATIONAL E-HEALTH AUTHORITY TO
DEFINE THE NATIONAL E-HEALTH ARCHITECTURE
E-Health Architecture: Key
features
 Information exchanges [HIE],
State & National.
 Registries and UID
 Set of Standards
 Flexible Data Input
 Flexible Data Output
 Online and offline modes
 Integration across systems
 Single System for field workers
 Multi modal connectivity
 Data privacy and security
 ICT for quality of care
 Capacity Building
 Procurement standardization

9. STATE HEALTH INFORMATION EXCHANGE –
PROPOSED ARCHITECTURE
Block1 Block2
Facility1 Facility2 Facility3
District
Admin
State HQ
Reprod.
& Child
Health at
National
Level
Hospital
Informati
on
Systems,
EMR
Reports
National
Disease
Program
s e.g.
Malaria,
IDSP,
NACO
State
Health
Program
s e.g.
EMRI,
HMIS,
DHIS
Nutrition
Birth &
Deaths
Private
Sector
As per Privileges
Facility1 Facility2 Facility3
Private
Sector
MOHFW
Reprod.& Child
Health
Directorates e.g.
Malaria, IDSP, NACO
Data Warehouse
Disease
Registry
Provider
Registry
Patient
Registry
[UID]
Facility
Registry
Document
Registry
Service
Registry
Most states have a paper based system that
collects aggregate data which is converted to
electronic form only at District level

10. STATE HEALTH INFORMATION EXCHANGE –
PROPOSED ARCHITECTURE
Nutrition
Block1 Block2
Facility1 Facility2 Facility3
Reprod.
& Child
Health at
National
Level
District
Admin
State HQ
National
Disease
Program
s e.g.
Malaria,
IDSP,
NACO
Hospital
Informati
on
Systems,
EMR
Reports
State
Health
Program
s e.g.
EMRI,
eMamta,
HMIS,
DHIS
Birth &
Deaths
Private
Sector
As per Privileges
Facility1 Facility2 Facility3
State1 Health
Information
Exchange
Portal
Block1 Block2
Facility2 Facility3
Reprod.
& Child
Health at
National
Level
Hospital
Informati
on
Systems,
EMR
National
Disease
Program
s e.g.
Malaria,
IDSP,
NACO
State
Health
Program
s e.g.
EMRI,
HMIS,
DHIS
Nutrition
Birth &
Deaths
Private
Sector
Facility1 Facility2 Facility3
Private
Sector
MOHFW
Reprod.& Child
Health
Directorates e.g.
Malaria, IDSP, NACO
Payers
Patient
Private and Govt.
E.g. RSBY, JSY
Data Warehouse
Disease
Registry
Provider
Registry
Patient
Registry
[UID]
Payment
Registry
Facility
Registry
Service
Registry
Document
Registry
Some states have built
capacity to collect
patient-based data thru
broadband and mobile
from the facility level

11. PROPOSED NATIONAL HEALTH INFORMATION
NETWORK
State2 Health
Information
Exchange
State1 Health
Information
Exchange
Portal Portal
Nutrition
Private
Sector
Block1 Block2
Facility1 Facility2 Facility3
Block1 Block2
Facility1 Facility2 Facility3
Reprod.
& Child
Health at
National
Level
MOHFW
District
Admin
State HQ
National
Disease
Program
s e.g.
Malaria,
IDSP,
NACO
Hospital
Informati
on
Systems,
EMR
Reprod.
& Child
Health at
National
Level
Hospital
Informati
on
Systems,
EMR
Reprod.& Child
Health
Directorates e.g.
Malaria, IDSP, NACO
Indicators Indicators
Reports
Reports
National
Disease
Program
s e.g.
Malaria,
IDSP,
NACO
State
Health
Program
s e.g.
EMRI,
eMamta,
HMIS,
DHIS
State
Health
Program
s e.g.
EMRI,
HMIS,
DHIS
Birth &
Deaths
Private
Sector
Nutrition
Birth &
Deaths
Private
Sector
As per Privileges
As per Privileges
Facility1 Facility2 Facility3Facility1 Facility2 Facility3
National Health Information Network
Payers
Patient
Private and Govt.
E.g. RSBY, JSY
Data Warehouse
Disease
Registry
State
Registry
Indicator
Registry
Payment
Registry
Patient
Registry
[UID]
Service
Registry

12. State2 Health
Information
Exchange
State1 Health
Information
Exchange
Portal Portal
Portal
Nutrition
Private
Sector
Block1 Block2
Facility1 Facility2 Facility3
Block1 Block2
Facility1 Facility2 Facility3
Reprod.
& Child
Health at
National
Level
MOHFW
District
Admin
State HQ
National
Disease
Program
s e.g.
Malaria,
IDSP,
NACO
Hospital
Informati
on
Systems,
EMR
Reprod.
& Child
Health at
National
Level
Hospital
Informati
on
Systems,
EMR
Reprod.& Child
Health
Directorates e.g.
Malaria, IDSP, NACO
Indicators Indicators
Reports
Reports
National
Disease
Program
s e.g.
Malaria,
IDSP,
NACO
State
Health
Program
s e.g.
EMRI,
eMamta,
HMIS,
DHIS
State
Health
Program
s e.g.
EMRI,
HMIS,
DHIS
Birth &
Deaths
Private
Sector
Nutrition
Birth &
Deaths
Private
Sector
As per Privileges
As per Privileges
Facility1 Facility2 Facility3Facility1 Facility2 Facility3
National Health
Information Network
Payers
Patient
Reports
As per Privileges
Private and Govt.
E.g. RSBY, JSY
PROPOSED NATIONAL E-HEALTH ARCHITECTURE

13. Hospital
Pharmacy
Telemedicine
Patient
Lab/ Rad
Payers
Health Information
Exchange for
Disease
Management
E-HEALTH ARCHITECTURE WILL ENABLE M-HEALTH
AND TELEMEDICINE FOR DISEASE MANAGEMENT
Ambulance

14. HEALTH INFORMATION SYSTEMS PILLAR
SUPPORTS HEALTH OUTCOMES
Report of Planning Commission’ Steering committee on Health has dedicated chapter 3 for HIS

15. THANKS
Contact: Dr Pankaj Gupta
Partner, Taurus Glocal Consulting
Independent Consultant, NHSRC.
Member ICT Sub-Group of Healthcare SIC under PMO GOI.
Dr_pankajgupta@yahoo.com
drgupta@taurusglocal.com
Website: www.taurusglocal.com
Blog: http://www.healthcareitstrategy.blogspot.com/
LinkedIn: http://www.linkedin.com/in/drpankajgupta