India has emerged as the leader in telemedicine with 400 plus telemedicine  centres operating across the country which extend clinical healthcare to remote  areas. But less than 50 percent of these facilities are active now. Irregular or no  power supply, paucity of technicians to maintain and train the users, inadequate  computers and internet bandwidth are few of the issues which plague telemedicine

Customised Mobile Solutions

Andy David
Director “ Healthcare,
SAP Asia Pacific Japan

I am primarily responsible for SAPs Healthcare Go-to-Market strategy across the region which covers market analysis, business development, customer reference and building SAP brand in these segments. SAP healthcare covers private and public hospitals and associated healthcare organisations across the region. Currently SAP has joined hands with hospitals in Hong Kong, Singapore, Malaysia, India, China, Indonesia and Australia. With over14 years in IT applications to Government, health and manufacturing sectors, we are now  working towards developing SAP mobile solutions.
The Computer on Wheels (COWs) is a new trend in hospitals and doctors today look for an iPAD rather than using a pen and a paper. Today in a hospital environment, IT is part of varied functions available from providing security to providing stability to the  various enterprise solutions. The customisation of proven mobile solutions within all the deployment is readily available. They can link with any device and any software such as PACS, RIS, ERP and finance along with SAP solutions. You could use all the systems in one view with easy user interface. SAP enables a winning mobile EMR strategy where they concentrate on patient security, a secure robust platform, scalable and readily deployable, packaged apps that are customisable, link to any clinical application, single source truth reaching all stakeholders, improving patient outcomes and patient satisfaction. Such mobility solutions can collaborate anytime, anywhere with instant information  access thus enhancing treatment quality and patient satisfaction.

Aim to develop an ICT vision document

PK Taneja
Principal Secretary,
Health & Family Welfare,
Gujarat

Gujarat is considered as one of the developed states and  its moving reasonably fast when it comes to health. In Gujarat we are trying to develop a vision document. Its the beginning and we are trying to develop to enhance the department, organisation, knowledge about IT and I think we are improving accessibility, affordability and quality of healthcare. We are in the process of strengthening the governance, increase overall accountability and efficiency of the system , and ensuring citizen centering and family friendly health systems. Over the last decade or so we have developed a large
number of applications. One of them is known as Mukhyamantri Amrutham Yojana which we have launched about 3 to 4 months ago. We are developing the Gujarat Hospital Management Information Systems, particularly for big hospitals, teaching hospitals, district hospitals and sub district hospitals.
We are developing a kiosk, which will help educate the citizens about the availability of doctors at various centres. In 2006, we were also part of the Drug Logistics Information and Management systems programme at primary healthcare centre level. This helps in some kind of decisions, where it provides a network and access to the suppliers along with online information about the stocks. Today we have about 513 direct demanding officers connected to the systems and it helps us to ensure reasonably better healthcare facilities. e-Mamta is a Mother and Child Tracking System developed by Gujarat in the year 2010. Now e-Mamta is much bigger, perhaps having 180 parameters and having about 100 different health indicators. Another good application which we have done for the last two to three years is GPS Mobile Health Unit. We have about 118 of them in rural area and underserved area, and now we are able to locate them, track them and monitor their performance through GPRS Technology.

Technology that trades along with healthcare

Partha Dey
Healthcare Practice,
IBM

The healthcare industry in India has a lot of challenges- 30 percent of Indians dont have access to primary healthcare facilities. Forty percent Indians fall below the poverty line each year because of healthcare expenses. Approximately,  30 percent people living in rural India dont visit hospitals because they are afraid of healthcare expenses. The healthcare needs of 47 percent of rural India and 31 percent of urban India are financed by loan or sale of assets. There are various possible solutions leveraging technology models where doctors / caregivers are available on phone. This facility can address lot of challenges of remote patient care, pre and post operation consultation, etc. However, key challenge is the payment mechanism. Rural health centres/ Panchayat office can have Skype-type video call facilities to connect to the district head quartered hospital.
The sensor devices in rural health centres can provide patient data to the doctors / caregivers in district hospitals. e-Tickets availability for government hospital can address long queues and wasting of time and electronic patient records, leveraging Aadhaar number, can address lot of challenges including the government immunisation drive.
Integration of all challenge is very important and we should have a common platform for integration. IT requires the investment without which nothing is  oing to work. The implementation of eHealth and mHealth initiative is not seeing the light of the day because of adoption issues. You have to handle it professionally as a change management. Choice of appropriate technology is important. We have to define this old map clearly to articulate, implement and adopt technology in phases.

NIC goes hand in hand with technology
Shefali Dash
Dy Director General, ICT Sector,
NIC

A centralised web-based application for improving delivery of healthcare services to pregnant women and children up to five years of age was introduced by MoHFW, GOI in technical collaboration with NIC in December 2009. It has been declared as a Mission Mode Project under the National e-Governance Plan (NeGP) in July 2011 with the objective that all pregnant women should receive Ante Natal Care (ANCs) services and Post Natal Care (PNCs) services. The society should encourage institutional delivery and all children should receive
their full immunisation.
NIC has developed e-Hospital which is now being implemented in about 19 hospitals across the country. Major ones are RML Hospital in Delhi, AIIMS in Delhi and many others. e-Hospital is a generic application, which addresses all the major functional areas of a hospital. This deals with complete treatment cycle of OPD/IPD patients and integrates various functions in the areas of clinical, administrative, and billing/insurance. It is an integrated HMIS Suite consisting of HIS, LIS, RIS, PACS, Blood Bank and Telemedicine Suite.
It confirms to HL7 standard so the data between hospitals is interoperable so that is one of the way to bridge some of the gaps. Mother & Child Tracking System (MCTS), derived from eMAMTA, which was started by the Government of Gujarat. So this is a total G2G portal used by the health officials at various levels like the primary healthcare, the block or state level, the district level or even the national level. They can also monitor the scheme like how many patients are there and there has been a unique mapping of all the health facilities, institutions, healthcare service providersi.e the ASHA workers through sms or workplan. We have recorded  99 lakh pregnant women who have been registered for taking the benefits from the government.

A systemetised approach to manage health information

Dr Pankaj Gupta
Consultant, Healthcare ICT,
National Health Systems Resource Centre,
Government of India

I am a health IT consultant and work with both public and private sector. We have done a study with the National Health Resource Centre (NHRC). This report has been published and converted into an international paper. Recently, we studied healthcare IT system at the national and state level and Rural Child Health system and we found most of the systems work in silos; they do not talk to each other. Each of the system is created as an application not as a product and if you have to look at any data across these systems it is impossible to do that. Technology being used was outdated, capacity development was not done. So change management was not done so what happened was adoption dropped after the initial spike. As a result the usage of most of the system was pretty low and the data was coming in different format. So it was difficult to make sense out of those data and it became data collection-system rather than decisionhelping system. For that we have painted a vision document for the Central Government. We said that you need to have the national eHealth authority that lays down the architecture for all IT systems that are out there. So lets compare this with a town planner. Town planner basically lays down standards for the roads for the water inlets, for the common areas etc. The town planner does into the floor planning for each building, each society and so and so. This is exactly what eHealth authority needs to do – lay down the standards for integrating all the different applications as long as each application, each system is able to give outputs and take the needed inputs from the others. There is some challenges around that which need to be managed. So national eHealth authority needs to  have thought so that it can make sure that people dont fly off to different directions.

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