Kerala State IT Mission
Dr. SMS is a novel project of the Kerala State IT Mission – the technology implementation wing of the Government of Kerala in India, launched on 29th May 2008 with the aim to increase access of health care services by common people through simple and innovative use of mobile telephony.
The State of Kerala is recognised the world over for its notable achievements in the field of health. With low per capita incomes, Kerala has managed to achieve health indicators that are at par with advanced countries. Kerala’s mortality indicators including death rate, infant mortality rate (IMR) and expectation of life at birth has got it a positive berth in the health status ranking across states of India as well as advanced countries.
This rosy picture can be quite misleading for outsiders who are not quite aware of the extent of health problems faced by Kerala. The glowing achievements in Kerala’s mortality indicators notwithstanding, all does not seem too well with the health sector here. There have been growing concerns about the rising morbidity levels in the State, led chiefly by the increasing incidence of lifestyle related diseases like diabetes, hypertension, heart diseases and cancer. Kerala also has seen a re-emergence of infectious diseases like leptospirosis, malaria coupled with increasing reports on diseases like Chikungunya and Dengue. The State also has the highest road accident rate in India.
For lifestyle-induced conditions like heart attacks, timely care is very essential to prevent further complications and even mortality. Known widely as the “golden hour”, it refers to the first hour of a heart attack. Getting medical help during this period greatly improves chances of recovery. The “golden hour” is equally pertinent in trauma care, which also mandates rapid medical intervention to improve chances of survival.
It is in this backdrop that the project Dr. SMS was conceived to facilitate quick information delivery on the nearest medical service centre. Kerala was also prompted to launch this m-Health project as it ranks as one of the leading States in India on mobile penetration. According to Telecom Regulatory Authority of India, in March 2008, Kerala has a tele-density of over 72 per cent as against the national tele-density of 32 per cent.
The project aims at improving health of the citizens of Kerala by:
Improving access to health care resources by making available authentic information on the same.
Providing timely information on medical and diagnostic facilities
Providing informational alerts about emerging diseases.
The main idea behind this project has been to enable people to use their mobile phones to receive information on health resources. The project aims at providing users with a comprehensive list of medical facilities available in a particular locality including hospitals with infrastructure and expertise in various medical specialties (cardiology, gynaecology etc), specialised doctors in the locality, all through the simple facility of the short service message (SMS). Since a SMS is used to gain information on medical services, the project has been named ‘Dr. SMS’.
The project was piloted in Kozhikode (Calicut) in the district of Kozhikode in Kerala. The choice of Kozhikode was based on the fact that it is the third largest city in Kerala with a population of approximately 20 lakhs. Kozhikode was also chosen for the project piloting because it has the highest rates of mobile penetration in the State. Kozhikode also attracts a huge migrant population/tourists, who are also one of the main targets of this project. The pilot project met with overwhelming success. The service was especially lapped by the large numbers of tourist population who did not know whom to contact in case of a medical emergency. During the pilot phase, an average of 200 daily transactions took place through the Dr. SMS facility.
To avail the facility all that the user has to do is send an SMS to a pre-designated number. Given below are some of the formats of inputs (SMS by the citizen) and outputs (SMS from Dr. SMS) in this platform:
Input – Health<space><Pincode><space><facility> – Example – Health 673004 heart Output – <Hospital Name> <Address> <Phone> – Example – Baby Memorial Hospital, Indira Gandhi Road, Calicut,Tel:04952723270, Fax:495723484
Input – Health<space><Hospital Name> – Example – Health BABY Output – Hospital phone No> <Major Facilities> – Example Tel: 04952723270, Heart, eye, Child, skin Facilities available
Input – Health<space><HospitalName><space><facility> Example – Health BABY eye Output – <Hospital phone No> <Facility Status> – Example – Tel: 04952723270, Eye Facility Available
The Dr SMS project operates at different levels and can be availed across various media. A message is sent with one’s pin-code and email ID generates an automatic system e-mail reply to specified ID. The project also incorporates a health portal and can be accessed at www.drsms.kerala.gov.in. This portal provides a Web-based information mechanism enabled via the Geographical Information System (GIS)-based details on various health-related attributes. The health centres can be easily located through the portal. The latitudes and longitudes of the health facility centres are also stored in the database. This GIS is regularly supplied with data and helps in providing an interactive map of the health facilities available across the city, how to reach those hospitals listed there. There are facilities available in the portal which can be accessed through the mobile and to fix the location the user is located in the map, or the same can be automatically fixed, if the user is having a GPS enabled mobile phone, this feature allows the user to search medical facility available within a selcted radius (5 Kms, 10 Kms, X Kms etc.). And will display in the map the routes.
The project has a credible and sound database on hospitals and emergency health centres drawn from a large data from the Health Infrastructure Survey, conducted by the National Commission on Macro economics and Health (NCMH), Ministry of Health and Family Welfare, Government of India. The system is supported by the National Informatics Centre and the State Information Technology Department.
Encouraged by the success of the pilot project, the Government announced the launch of the project in all districts of Kerala. The project was launched State-wide launch by the Hon’ble Minister for Health and Family Welfare on 20th July 2009. The facility is now fully operational with the database of details of about 8 out of 14 the districts of the state and the rest of the district data will be appended to the database soon As part of the State-wide implementation, centralized facility for Dr. SMS has been established at Government owned secure state of the art tier 3 State Data Center, Trivandrum and a ‘Long Code’ for the State (9495949000) has been established, and this facility is accessible to subscriber base of all the mobile service providers in the State and even from any operator in India, ‘pan India reach.
The major achievement of the project is its enshrined ability to deliver health related information to the citizens, including location hospitals, medical centres, facilities and doctors in a time-sensitive manner.
The project is noted for its cost affordability and effectiveness. To send the message, the customer has to pay a nominal amount of 40 paise or less. The cost of the return SMS is borne by the Government of Kerala.
The service has come to be seen as a first aid kit for any health emergency for the large number of tourists who are on the move in the town and are not aware of the whereabouts of the place.
The project has helped hospital authorities prepare the emergency room as per the requirements as well as to mobilise the resources like specialist doctors and specialised equipment to take care of the emergency.
The State-wide launch of the project in a little more than a year of the launch of the pilot project speaks of its achievements.
To conclude, by leveraging the other segments of mHealth, like improving ability to diagnose and track diseases, providing timelier, more actionable public health information and expanding access to ongoing medical education and training for health workers , the project can influence people to manage their health better and provide complete continuity of care. Concentration on such aspects will lead to improved focus on the new roles of providers and patients and pave the way for participatory health management in Kerala.