The role of ICT in improving healthcare
May 24, 2012
In an emerging economy like India, the health sector’s performance is often suboptimal due to an increased burden of factors like underdevelopment, political instability, weak institutions, inadequately developed social sectors, scarcity of resources, and marked social inequalities. Though huge budget outlays have been made by the government under ambitious social sector schemes like the National Rural Health Mission (NRHM), accessibility of low-cost healthcare continues to elude many. With low-cost innovation, cheap mobile handsets and more ‘inclusive’ solutions filling in crucial gaps in health information and access, technology has a potential to grow capacity in this sector tremendously.
Information and Communications Technology (ICT) has the potential to impact almost every aspect of the health sector. In public health, information management and communication processes are pivotal, and are facilitated or limited by the availability of information. In addition, beyond the formal health sector, the ability of impoverished communities to access services and demand a healthcare system that responds to their priorities and needs can be significantly influenced by broader information and communication processes, mediated by informed decision making.
It can help patients become more involved in their own care, which is especially important in managing chronic conditions like diabetes, asthma, or heart disease. Primary healthcare costs can be cut, where remote access can be facilitated via innovation in telemedicine, cutting down the need for those in remote areas to forgo a day’s work and wages in trying to get to a doctor for minor ailments. In addition, it can help streamline processes and reduce administrative overheads, as it has in other industries, while leading to the creation of new, high-tech markets and jobs.
Institutionalisation of ICT for better healthcare
The use of ICT has grown considerably in recent years and has triggered a great deal of interest in an age of rapidly-spreading epidemics that don’t respect national boundaries, transforming the very nature of healthcare. In India, though, unlike the institutionalising of the use of IT for better delivery of public services via e-governance, the failure of policies to keep pace with technological progress has meant that the benefits of ICT in healthcare have not flowed down equally to all.
For instance, e governance has been institutionalised, via ways in which the use of ICT is becoming a norm for various government departments. Constant thinking about, and revision of, ICT policies have ensured that there is enough attention being given both to the benefits and challenges of the use of technology. Similarly, it is felt by many healthcare professionals that if the same is done for the health sector, it might help in enhancing the adoption of ICT in health care.
Building and managing a skilled workforce
The human resource (HR) crisis in health is widely acknowledged. At present, most government HR functions remain fragmented within the health sector, these functions are often either the responsibility of clinicians who direct health facilities – and have little or no preparation in human resource management – or are the responsibility of ‘personnel administrators’ who have been trained to handle routine civil service policies and procedures.
There is an urgent need to professionalize this role and develop a cadre of well-trained HR managers, especially in large public sector health institutions, which often lag behind their private counterparts. This would include expanding both the number of HR managers and the organisational view of their role, as well as helping upgrade their skills. Human resource development is not only critical with respect to the technical capacity to create, distribute, and use information but also in terms of addressing the new demands on the skills of health professionals.
The benefits of incorporating ICT in healthcare include better access to complete and accurate electronic health records that aggregate information to improve diagnoses, prevent errors, and save precious response times; lead to greater engagement of patients in their own healthcare; improve population-based knowledge in a diverse country like India, and usher in increased administrative efficiency in a country where the public health infrastructure is in a mess. For example, administrative tasks (such as filling out forms and processing billing requests) represent a significant fraction of healthcare costs. Health IT could streamline these tasks and significantly decrease costs, as well as reduce personal visits to doctors. For those living in remote areas, this often means forgoing an entire day’s wage. ICT in healthcare can enable remote consultation, diagnosis and treatment through telemedicine.
Examples of successes from across India
In India, the use of ICT in healthcare has seen varying success across states, due to different levels of engagement with the latest technologies. An example where this has helped is in the use of Personal Digital Assistants (PDAs), albeit on a pilot basis, by auxiliary nurse midwives (ANMs) – crucial links in the primary health care system as envisaged by the NRHM. This has helped reduce time-consuming paperwork and increased data accuracy by ensuring the broader availability of data in electronic form, even in rural areas with limited broadband connectivity. These PDAs are being used to transmit data through wireless communication networks, which can be entered into a larger database using the Internet.
In India’s largest state Uttar Pradesh – which has its share of development problems – a health programme called ‘Aarogyam’ was launched as an end-to-end community-based digital health mapping project. Through this, citizens anywhere in India on any existing telecom network, can access information with respect to their health profile. It also provides a health database for a future healthcare strategy. Then there is the Mother and Child Tracking System under the NRHM, where the focus of the project was to keep track of each pregnant woman from registration to post natal care.
In Tamil Nadu, Health Information Systems was successfully launched to strengthen information practices within primary healthcare with the larger aim to improve processes concerning healthcare delivery for the rural community. A significant percentage of the rural population is poor and resides in remote areas, hence directly depending on the effectiveness of primary healthcare for addressing the health problems of communities. The main objective was to devise and strengthen Health Information Systems and develop the capacity of the health staff to work on computers, with the ultimate aim that this would lead to better governance of the health sector and improved delivery of healthcare to the community.
Another example is that of GVK EMRI, which handles medical emergencies through the “108 Emergency service”. This is a free service delivered through state of art emergency call response centres. It has ambulances across the states of Andhra Pradesh, Gujarat, Uttarakhand, Goa, Tamil Nadu, Karnataka, Assam, Meghalaya, Madhya Pradesh, Himachal Pradesh and Chhattisgarh. As per records, response times, and cases treated, healthcare services in the above-mentioned states have improved, especially in some of the less accessible areas.
Challenges and Opportunities
Despite these isolated successes, public health IT systems in the country exist in silos. Most programmes and even state health departments have their own IT solutions for program reporting needs. Since all systems work in silos they do not assist in integrated decision making. Thus, there is a lack of standardisation in architecture, data standards, disease and service codes.
The increasing healthcare needs of an aging population, expensive technologies, a shift toward community-based care, the need for improved access, and quality, as well as the desire of people to be more directly involved in decisions about their health represent significant challenges and opportunities in a country like India. Health information plays a key role in determining how these challenges are met. Add to these the long list of brick-and-mortar infrastructure gaps, capacity building, training of health professionals who are ICT-illiterate, and the lack of primary healthcare staff, and it is easy to see why the Indian healthcare sector offers an array of opportunities for low-cost innovation and the application of technology for improving health outcomes.