Effective IT policies to save lives

The opening up of the Indian economy by what is popularly known as LPG (Liberalisation – Privatisation and Globalisation) during the early nineties heralded a spell of unprecedented economic growth in India. The growth rates witnessed tallied and often exceeded those of the fastest growing economies, the result of which was a confident and resurgent Indian industry making forays into almost all the sectors of economy. Healthcare has also witnessed a steady growth in investment, budgetary spending, employment and proportionate improvements in outcome, including clinical outcomes.

Technology in the last two decades has revolutionised the way healthcare is delivered worldwide. It has greatly aided patients and providers alike by enhancing the quality of delivery, reduction in turnaround time of work-flows and thus the overall cost, besides bringing in higher accountability into the system. Advancements in medical science and technology are playing a positive role in saving lives. The influence of medical technology is all pervasive – its positive impact is not only limited to the upper crust of society but has also helped the not so privileged sections.

A quantum jump is being planned during the 12th five year plan period, with sizeable increase in budget and a slew of policy and programme initiatives. 12th five year plan has recognised health as the top priority sector with the High Level Expert Group (HLEG) recommending universal healthcare (UHC) for all citizens through budgetary support (as a means of healthcare financing) – by increasing the current support level of ~ 1.2 per cent to 2.4 per cent by the end of 12th plan and to three per cent by 2022. The ten guiding prinicples for the formulation of these recommendations for introducing a system of UHC in India: (i) universality; (ii) equity; (iii) non-exclusion and non-discrimination; (iv) comprehensive care that is rational and of good quality; (v) financial protection;(vi) protection of patients’ rights that guarantee appropriateness of care, patient choice, portability and continuity of care; (vii) consolidated and strengthened public health provisioning; (viii) accountability and transparency; (ix) community participation; and (x) putting health in people’s hands. Each of these principles can be leapfrogged to achieve their respective goals with assistance of IT systems.

Centrally funded agencies like Employees’ State Insurance Corporation (ESIC), armed forces and state governments have implemented solutions around healthcare and this is the very reason to believe that what is happening in a few of these initiatives can be replicated for a seamless, integrated state-wide and nation-wide e-Health, as is being attempted by a large number of countries worldwide. It is possible for India too to move in that direction, if measured and implementable steps are initiated.

Some of the core policies which government has already set their eyes on or on the path of the same are the following:-

Digital signature

Digital signature enables the subscriber to authenticate the electronic record created by the person. It is bound cryptographically to an electronic identity, to an electronic document and the digital signature cannot be copied to another document. Digital signature can be a good replacement for traditional system of ink signature and can be used widely specifically in healthcare where acceptance of the same should be legalised as per section 13-14 and 15 of the Information Technology Act, 2002. This would enable widespread use of IT applications/ EMR across the hospital for clinical usage by clinicians and nurses. This would make the legally required case sheets-flow sheets redundant and hence a giant leap towards acceptance of patient centric EMR.

Standards

Despite healthcare innovation we are falling dangerously short of providing and accessing consistent quality healthcare due to our inability to get data spread across varied island of information systems, spread across care system ranging from sub centres, PHCs, tertiary care to private hospitals. This information loss is extremely costly, both economically as well as loss of life. The Ministry of Health has recognised this and set up a committee to recommend standards around data security and privacy-disclosure standards, interoperability standards and data ownership standard. Unfortunately it has no real teeth to implement the same across the country; hence these gaps or shortcomings have to be filled up byrequired legislation and guidelines for implementations of the same.

One of the easiest ways to is achieve this is by enacting regulations and certifications of software products dealing with hospital information system/ EMRs. This will ensure the usage of these standards in vendor products and services.

Direct Benefit Transfer for healthcare

While Aadhar is getting to be the most viable option of authenticating and validating the direct benefit transfer (DBT) and currently covers three areas of work–student scholarship, LPG subsidy and national child labour, it should be extended to healthcare as well. One such well known example is Brazils-Bolsa Familia, families below a particular income threshold are provided grants on fulfilling certain conditions like attendance at government clinics and 85 per cent school attendance.

This would bring in a paradigm shift from hospital-based care to preventive care empowered for the patient and by the patients assisted outcome-based DBT.

While the responsibility for the delivery of healthcare services rests largely with the State Governments, the Central Government sets policies, provides resources and oversees overall progress in the sector as a whole, including that of nationally formulated programmes. Instead the government should formally legislate healthcare-IT/e-Health policies as a central subject and should be the driving force for the same across the state, with delivery of care still being a state subject.

Wipro syndicated a study with Dun and Bradstreet (D&B) titled Future Thought of Business (FTOB): Healthcare. It identifies key drivers that reinforces the future imperatives of this business:

• Increasing penetration of both private insurance and Government health insurance schemes will bring more people under the healthcare net and will drive demand for preventive healthcare services
• The demand for healthcare services will be driven by both urban and rural markets in the coming decade with a distinct shift towards life styles and chronic diseases.
• The attractiveness of the Indian market will entice more foreign players through capital investments and technology tie-ups across various segments such as hospitals, diagnostics, medical equipment etc.
• High operating costs in the metro cities and fear of over-supply will drive more healthcare companies to increase their focus on the untapped smaller towns
• The growing medical travel sector in India will benefit from rising cost burden of national healthcare system in the developed economies.
• Large number of single speciality hospitals will come up especially in India’s tier II and tier III cities driven by rise in local incomes and awareness level, in areas of heart, cancer, ophthalmology, maternal –child care, and cosmetology.
• The need to optimise costs and increase efficiencies will make IT an integral part of hospital management.

References:

1. Planning Commission Report:-planningcommission. nic.in/reports/genrep/rep_uhc2111.pd
2. Department of Telecommunications-Government of India – www.dot.gov.in/act-rules/information-technology-act-2000?
3. Standards Committee – Ministry of Health and Family Welfare