June 2018
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Health IT adoption in Primary Healthcare: The answer is not more of the same

By ICTpost Health IT Bureau

Health IT can help unserved communities in India

Health IT can help unserved communities in India

The rural health system of India is plagued by serious resource shortfall and underdevelopment of infrastructure leading to deficient health care for a majority of India. The differences in urban-rural  ealth indicators are a harsh reality even today. 42% of India’s children below the age of three are malnourished, which is greater than the statistics of sub-Saharan African region of 28%. Diseases such as dengue fever, hepatitis, tuberculosis, malaria and pneumonia continue to plague India due to  increased resistance to drugs. India is ranked 3rd highest among countries with a high rate of HIVinfected persons.

While the powers of healthcare IT to radically transform the health of a patient population are widely lauded, one thing that isn’t discussed as much are the areas where the technology could do the most good but doesn’t often reach to.

Tough, the inroads health IT can make in these populations, and provided some key insights on how health IT can benefit minority populations and how to reach them.

Are there big factors holding developers back? One of the problems in getting health IT to reach underserved populations is that there is a lack of developers working to create applications for those groups. There’s no real personal connection to the populations that are the most underserved. The first big step to take is to connect with the underserved populations and to begin to understand the communities and their needs. People need to build those bridges so they can take the amazing things they’re doing that are so creative and make them useful to those who really need it. Partnering with local organizations can be a way to break the ice and get input on how best to reach people.

We can work now with what we have and where we are and if we educate, there will be this great population who’s able to continue to do it moving in the future.

Concerns around cost. The cost of health IT is often seen as a factor that holds it back from underserved populations. If we design things that are for populations that often times have the worst disparities … but also produce some of the highest costs, then we have an opportunity to reduce costs in healthcare.

Go local first, and then scale up. Launching an initiative aimed at underserved populations can be a daunting task. Many minority groups are simply not understood well enough to have an effective health technology partnership. Starting with a focus on a particular local group a nd partnering with a community is one way to create a lasting, scalable model for success. Even if a community group isn’t particularly tech- or healthcare-centric, they still are a valuable partner who understands the populace and can help communicate and engage with people. Once a local project begins to take off, those lessons can be scaled up. You’re going to learn some basic principles in worthing with local organizations that you can apply on a national level. Communicate. Collaborate. Because minorities are often misunderstood or underrepresented, developers are not often willing to jump in to uncharted territory. This is partly because “people aren’t always ready to ask the tough questions or hear the tough answers. For communities, you’re going to hear the tough answers.” What matters in launching a project designed to target health matters in underserved communities is an open and effective line of communication. Taking the time to build relationships, and not jumping in and jumping out, I think are the key things. This all needs to be part of the communication process.

Rural e-Health Software The issue of rural e-Health software is a complex one. There are hundreds of open source Electronic Medical Record (EMR) systems supporting different platforms available around the world. These range from full-fledged hospital management solutions to community EMRs, to personal health records. The advantage of open-source applications is reduced costs, flexibility to customize, and sharing of knowledge with developer community and users.

Challenges of Reliable Network Connectivity
The network connectivity is a major component of rural e-Health setup. So far it has been the most difficult and expensive to manage. In a sparsely populated area, it becomes very expensive to use wireline technologies, and cellular phone companies cannot recoup their investments. However, global R&D is producing some innovative technologies which can address these pressing issues.

The vital components of e-Health are mobile hardware, which can be taken into patient’s dwellings and has support for network access, software for accessing records with some decision support built in, reliable network which is low cost and connects mobile workers to the central base or a national grid, and most importantly the power source, for providing electricity in remote areas.

mHealth and Rural Healthcare
To reap the maximum benefit from mHealth, all the stakeholders, namely, governments, private healthcare providers, technology providers and NGOs, need to team up to set some standards, share experiences and best practices from pilot projects undertaken in most developing countries.

With the 3G network in place, some of the issues related to data and image transfer in case of remote  treatment and diagnosis will be addressed. Some of the key takeaways as the next steps towards mHealth initiatives would be as follows:

  • Population behavior change needs to be focused towards adoption of mHealth applications in rural areas
  • Telecom operators would need to address the problem of unreliable and weak mobile network services in remote/rural areas
  • Need to address the limitations of mobile phones with reference to connectivity with various medical devices, data transfer, data security, data interpretation and the scalability of operations 
  • The training of users at the grassroots for using mHealth applications has to be effective for best results
  • Other issues also exist related to language, bandwidth, logistics, compatibility, ease-of-use, etc
  • A framework or infrastructure needs to be designed to manage and evaluate such programs in order to improve their efficiency, effectiveness, scalability, and sustainability

The Last Word

There are many technologies that are either in research stage or pilot testing phase, which can address any of the four components for rural e-Health in emerging economies. Any integrator who could bring these technologies together around an e-Health application would not only be able to provide quality healthcare delivery to millions of people, but would also lay the foundation of a medical communication network. This requires high initial capital investment, collaboration with multiple agencies, clear ROI assumptions and measurable project outcomes. It is right to assume that with the limited healthcare-IT deployment in urban centers, it is very difficult to push it in the rural centers. But the fact is the potential benefit of e-Health in a medically underserved area is much greater, so as to justify the investment. editor@ictpost.com