November 2017
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Leveraging  ICT and Mobile phones for Redefining Primary Healthcare

By Gp Capt (Dr) Sanjeev Sood , NABH Empanelled Assessor

ICT has made the delivery of healthcare more efficient, effective, accessible & safer across the care continuum for both, patients & providers. It holds immense promise of changing medical practice towards redefining PHC acheivement of SDGs.

 

Indian Health Sector (Public) Overview

Health Sub-centres 1,45,894; Primary H Centres  23,391; Community Health Centres 4550; District Hospitals  585; Tertiary centres, medical colleges (Modern system 300)

ICT as an enabler

¶ Technology has revolutionized worldwide the delivery of healthcare
¶ Delivering of quality healthcare & positive clinical outcome
¶ Cost containment,  reduction in T A T of workflows
¶ Reduced workload, Medication errors & Space requirements
¶ Faster access to patients MR,audit trail
¶ Compliance with Govt regulations

Role of Mobile Phones in Increasing Accessibility & Efficiency in Healthcare

Voice & Text Applications
–Tackling inefficiency in service provision by improving communication & interface eg., missed appointments, compliance,due dates for vaccinatn
–Contacting Blood Donors
–Increasing the ability of some inaccessible groups teenagers, mobile & working pop to access health service by reducing the barriers
v3G Networking application
–Transmitting data – image, ECG
–Patient educatn through web based services

NRHM – Gets the IT Edge

•Health Statistics Information Portal – a web based MIS – facilitates speedy & efficient flow of information from periphery to centre
•Tools for advanced data analysis, reporting, monitoring, evaluation & programme management
•More efficient public health planning & forecasting for service provisioning, emergency preparedness ,resources mobilization
•Objective – data for Action

Integrated Disease Surveillance Project
•IDSP, launched by MOHFW in 2004,
•A state based Surveillance Program intended to detect early warning signals of impending outbreaks & help initiate an effective response in a timely manner.
•Uses IT for collection, collation, compilation, analysis & dissemination of data .
•Facilitates achievement of MDG Goal: 6 in effective monitoring & combating of major infectious diseases.

•Early Warning & Response System-Remote Sat Imagery +GIS+Met data
•Outbreaks of infectious dis, vector borne diseases-Cholera , SARS can be quickly analyzed using GIS tools.

e – Mamta

•Launched in Gujrat state to combat high MMR
•A comprehensive IT application for mother & child tracking system from pregnancy till complete LC for better public health services delivery .Covers the entire rural, urban slum pop.
•Application generates unique health ID for every mother & child ; ensures complete continuum of ANC delivery to reduce IMR/MMR.

Pregnancy Tracking System , Dungarpur
•IT driven solution has changed the prospects of maternal health -A SW created by IL & FS
•Info is sent by ANMs at the Sub Centers through mobile text messaging as ASHAs report to them regarding pregnant women in their areas.
•Complete Hist is recorded in live data base. Data is given to the blocks & then to districts & monitored at DC’s office.

•Tracks women during ANC & when approaching EDD ,advice them for institutional delivery. Can also track children after birth for immunization & married couples for family planning counseling.
•The rate of institutional deliveries has gone up by 70% in last 2 years, significantly higher than the majority of the country despite lack of resources & infrastructure.
•IMR in Dungarpur is now down to 49 (state :65 ) /1000 live births & MMR to 281 (state:388) /1000,000 live births.Haryana is also implementing its PTS

 
IT Application to Monitor Growth of Pre-term Infants

IT solution for monitoring weight & growth of preterm infants in NICU

•Growth: a screening tool to diagnose diseases in neonates.
•Growth Retardation: can have scarring consequences into adulthood

•A screening tool where electronic data is captured that is easy to manage & analyze.
•Maternal & infant information is captured, followed by daily recording of BW, weekly measurement of recumbent length, head circumference & mid upper arm circumference & co morbid conditions (ICD 10) in a pre-term infant by any number of devices that support this application.

•Application has features to display the std reference curves; plots the wt measurements against the reference curve background & display the same in tabular form.

• Pilot data generated at a 35 bedded level III NICU of the St John’s Hospital shows that the Indian preterm infants fall on/ below the 3rd percentile of the std reference curves for the western pop. Data gathered from the reports can be exported to Excel & further analyzed.

Save the Baby Girl
•Project first launched on 15 Aug 09,  districts of W Maharashtra
•Project has 2 phase application, online submission of records as per PCPNDT Act 2003 & Silent Observer (SIOB), an advanced, secured & intelligent device embedded to the ultrasound machine that records the video images of the ultrasound.
•SIOB is a device that is attached externally through cables & that captures the video images of the each sonography conducted & stores in the local hard drive of the SIOB.

•The information logged on to the web server is then collected on centralized web server & application then generates various reports & statistics to identify the key indicators such as total number of patients registered by centre, area specific (rural, urban, tahesil etc.), number of MTPs, deliveries, (normal, abnormal etc), & birth results such as live, EUD etc., to monitor the performance of each centre.
•The entire data is processed & displayed using online dashboard to have a summary status of the entire district on a single screen, categorized as rural, urban, progressive & monthly statistics. The individual login for various levels of district administration is planned so that concerned authority will view the reports of the area defined to him/her on personalized dashboard.

•The intelligent reading & careful analysis of the generated information & reports by the administrator pinpoint the culprit centers of sex determination tests  & results in  inspection of such sonography centers by the appropriate authorities  &      punitive actions are initiated.
• The figures of male & female born in private maternity homes with sonography machines, for Oct to Dec 2009 indicate improvement in sex ratio in favour of girls.
•The interaction with medical fraternity, especially with the respected doctors, known for their integrity & ethics revealed that the success in improving sex ratio is due to continuous online monitoring of all center on daily & weekly basis & feedback given to the doctors/radiologist of sonography centers even for minor lapses.

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