This article is written for Modern Medicare on the Role of IT in Indian Healthcare system. This article talks about the policy changes in India for Healthcare IT, Telemedicine and mHealth ( Digital Health )

1. Policies & Regulations: IT-enabled systems
Transforming the way we deliver healthcare
Indian healthcare will remember the year 2012 for two major policy changes; government’s decision to
increase the healthcare spending to 2.5 per cent of the GDP and its decision for a move to ‘Universal Health
Coverage’ for all citizens. What the practitioners, providers and patients are missing out is the fine print or
rather the blueprint of one major change that will follow during the implementation of this mega scheme.
Let us scan the details.
T
he big change that will follow
this year’s development on
healthcare by the government
is the implementation of
nationwide, patient wise IT-enabled
systems. So, let us look at the two
documents related to healthcare policy
that touch upon this very important topic,
ie, the use of IT.
Spurring growth
According to the High Level Expert Group
Report (HLEG) on Universal Health
Coverage for India, “We envisage that
over time, every citizen will be issued an
IT-enabled National Health Entitlement
Card (NHEC) that will ensure cashless
transactions, allow for mobility across the
country and contain personal health
information. Such a card will
also help the state to track
patterns of disease burdens
across the country.”
Recently, the 12th Five Year
Plan document has been released and let 20.98. A composite Hospital Information 6. Financial management in the
us examine the fine print of this document. System (HIS), when fully operational, public health system to streamline
According to the ‘Twelfth Five Year would incorporate the following: resource allocation and transfers, and
Plan (2012–2017) Social Sectors, Volume 1. Universal registration of births, deaths accounting and payments to facilities,
III, which has a dedicated section on and cause of death. providers and beneficiaries. Ultimately,
‘Information Technology In Health.’ 2. Nutritional surveillance, particularly it would enable timely compilation of
among women in the reproductive age the National Health Accounts on an
20.97. Information Technology can be group and children under 6 years of age. annual basis.
used in at least four different ways to 3. Disease surveillance based on reporting 7. A national repository of teaching
improve healthcare and systems: by service providers and clinical modules, case records for different
1. Support public health decision making laboratories (public and private) to medical conditions in textual
for better management of health detect and act on disease outbreaks and audio-visual formats for use
programmes and health systems at and epidemics. by teaching faculty, students and
all levels. 4. Out-patient and in-patient information practitioners for Continuing Medical
2. Support to service providers for better through Electronic Medical Records Education (CME).
quality of care and follow up. (EMR) to reduce response time in 8. Tele-medicine and consultation
3. Provision of quality services in remote emergencies and improve general support to doctors at primary and
locations through telemedicine. hospital administration. secondary facilities from specialists at
4. Supporting education, and continued 5. Data on Human Resource within the tertiary centres.
learning in medicine and health. public and private health system. 9. Nationwide registries of clinical
60 I January 2013

2. IT-enabled systems
establishments, manufacturing units, Digitising healthcare supply system on the lines of Tamil Nadu
drug-testing laboratories, licensed We know that all sectors, be it banking or medical services supply corporation. This
drugs and approved clinical trials railways are any other sector, has benefitted is certainly going to digitise the supply
to support regulatory functions of immensely by deploying IT. Using IT chain in public healthcare system
the government. end to end - from centre to the village “Never too old, never too bad, never too
10. Access of public to their own health level, is the key to success of the 12th Five late, never too sick to start from scratch once
information and medical records, while Year Plan targets for healthcare. IT will again,” said Bikram Choudhury, and it is
preserving confidentiality of data. bring out transparency, which will lead to time Indian doctors start using IT in their
11. Programme monitoring support for accountability in healthcare spending and daily practice.
National Health Programmes to help better outcomes for providers. IT can be It is also clear from the government
identify programme gaps. used for: documents that private sector will also
1. Setting the targets at the central , state, provide healthcare facilities under public
20.99. To achieve these goals, regional, district and village level financing and would be reimbursed under
computers with Internet connectivity 2. Timely review and corrective actions various Public-Private Partenership (PPP)
would be ensured in every Primary 3. Disease surveillance, epidemiology models. Insurance companies will demand
Health Centre (PHC) and all higher and planning real-time system for adherence to treatment
level health facilities in this plan period. 4. Instant disbursal of funds and online protocols, online pre-approval, payment
Connectivity can be extended to sub- approvals to ensure that the decisions & accountability. This cannot happen
centres either through computers or are taken with the speed needed in without IT. Even individual doctors who
through cell phones, depending on their case of healthcare emergencies have to reimbursed by the government will
state of readiness and the skill-set of need to have the IT systems. It will not
their functionaries. All district hospitals be a surprise if India also implements the
would be linked by tele-medicine No one will remain untouched ‘accountable care guidelines’ & ‘meaningful
channels to leading tertiary care centres, from using IT in the next 3 use of IT’ in healthcare, on the line of the
and all intra-district hospitals would US healthcare system.
years in healthcare. It is
be linked to the district hospital and “All great changes are irksome to the
optionally to higher centres.
time to accept this reality human mind, especially those which are
20.100. The role of the Ministry of and start adopting IT in attended with great dangers and uncertain
Health and Family Welfare (MoHFW ) daily practice starting with effects,” said John Quincy Adams, and
would be to lay IT system standards, patient registration, EHR the IT adoption is not going to be easy
and define indicators which would be to prescription or even but is unavoidable. The government must
openly shared. States will be funded start a ‘bridge course’ (online 3–6 months
follow-ups.
for their initiatives in this field at duration) for healthcare professionals
primary or secondary levels through to enable a smooth adoption of IT for
the National Health Mission. Health doctors. Also, the newly constituted
surveys would be annually conducted UID has already been allocated to 210 National Commission for Human
to generate district level information million people and cash transfers will be Resources in Health (NCHRH) must
on health status, which will also serve happening across 51 districts from this consider including IT (health informatics)
to verify the accuracy of routine health year. It is very likely that UHC will be in the medical curriculum for doctors and
information system. based on National Health Entitlement also for paramedics.
Having a close look at these two Card (NHEC). This should serve as a The first major change IT brought
policy documents and taking into wake-up call for our doctors who have was in communication, next big change
account the changes that Unique till now desisted from using IT in their IT is bringing is in cash transfer for
Identity (UID)– Aadhaar card has daily practice. They might be late, but for subsidies from the government and the
delivered for direct cash transfers, it is sure, no one will remain untouched from next big change IT will bring would be
clear that next big change would be in using IT in the next 3 years in healthcare. in healthcare delivery. Wait for the good
healthcare. With an expected budget It is time to accept this reality and start times to come!
of ` 2.8 lakh crore for healthcare, it is adopting IT in daily practice starting with (office@rajendragupta.in)
very important that the government patient registration, Electronic Health
plans to spend about 2 per cent of the Records (EHR) to prescription or even
healthcare budget on IT (expenditure follow-ups.
on m-Health & telmedicine excluded)
Rajendra Pratap Gupta
& digitise healthcare. Let the good ‘IT’ times roll… International Healthcare
Let us examine in detail the scope of The 12th Plan document also suggests all Policy and Retail Expert
digitisation in health. states to have an online procurement and
January 2013 I 61