The first eHealth World Forum was held from 1st -3rd August 2011 to create a platform for dignitaries from all over the world and discuss emerging issues in depth in the areas of IT and technology in the healthcare services sector
eHealth World Forum, held in conjugation with the eWorld Forum, aimed at providing a unique platform for knowledge sharing in different domains of ICT in healthcare Conceived and produced by CSDMS and Elets Technomedia, the event was coorganised by the Department of Information Technology (DIT), Ministry of Communications and Information Technology, and Department of Science and Technology, Government of India. The forum was followed by eHealth World 2011 Awards, which were instituted with the primary aim of felicitating and acknowledging unique and innovative initiatives in healthcare. Health IT is undergoing a paradigm shift inviting greater initiatives from the industry and such events encourages converging and planning recommendations for reforming policies in the sector.
Government and private sector Initiatives in Development and growth of healthcare sector
The first session of day one of eHealth track started with a vision address delivered by Anju Sharma, Mission Director, NRHM on Government Initiatives in healthcare.
She deliberated that, “Gujarat has been an enthusiastic state to bring quality healthcare to the citizens with a long range of programmes such as Chiranjeevi & Balsakha Yojana (PPP), 108 EmergencyTransportÂ and e-Mamta Mother & Child tracking (IT application). We have district quality accreditation boards Quality Assurance Group (QAG), Quality Improvement Programme (QIP), NABH.”
She added, “Gujarat is the first state which has accredited PHCs in tribal areas by NABH, blood banks, food and drug laboratory and of course the hospitals to involve quality consciousnessÂ Â into the system. The most talked about programme initiated by Gujarat in the year 2006 is the Chiranjeevi Yojna which is a unique PPP initiative to partner with private sector facilities for BPL and tribal mothers. There is an evident reduction in number of maternal deaths and we could infer to have saved approximately 893 mothers.”
Talking further she said, “The Bal Sakha scheme provides expert care to newborns up to one month by private pediatricians / trust hospitals free of cost. The emergency ambulance 108 was initiated in the year 2007, which answers 99 percent calls and so far has attended total emergencies to be around 15, 51,718.”
Illustrating Gujarat’s healthcare IT initiatives she said, “e-Mamta mother and child tracking web based application is uniquely designed management tool being uted. It is credible tracking system that would enable health workers to reach above mentioned goals.”
She concluded that in healthcare delivery innovation is important because there are facing challenges in healthcare delivery of access, availability, affordability and quality.
Dr Pervez Ahmed , CEO and MD, Max Healthcare elucidated on the scope of PPP modalities and their challenges in the Indian healthcare scenario. He said, “It is important to know who the enablers of healthcare are. Private sector and public sector need to understand the societal need by involving private sector and increasing GDP for health budget.”
He further added, “Delhi has 38,000 private hospital beds and 3500-4000 beds are contributed by the major private players like Max, Apollo and Escorts and the rest of them are contributed by the 15-25 beds nursing homes. The problem lies in the unregulated sytems. We have to look into a different model of delivery. Max also works through a PPP model by giving revenue to the government and through insurance company cover approximately 4000 people are given treatment at much lower prices.”
Dr Ahmed concluded that, “Success of any partnership is when they have mutual benefit. The obligation should be clear in terms of transparency, incentives and regulatory framework. A proper system can thus provide high quality healthcare at affordable cost.”
Dr P Saxena, Director, Central Bureau of Health Intelligence (CBHI), Ministry of Health and Family Welfare, Government of India majorly emphasised on the healthcare system in India & flow of information between stakeholders. He said, “The flow of information takes place with effective IT application and maintains family based records. The information is compiled from CHCs and PHCs and reported to the State/UT Headquarters on a weekly/monthly/quarterly basis in the prescribed format which was further strengthened and improvised by the CBHI and NRHM.”
He then briefly explained the work structure of CBHI. It collaborated with WHO to develop medical record education and training programme and use International Classifications of Diseases (ICD) for coding of mortality and morbidity. The work primarily focuses on compiling entries related to health sector policy reform
database of India and being updated from time to time. It also maintains HS-PROD, which is a web-enabled database that documents and further creates a platform for sharing of information on good practices and innovations in health services management.
He concluded, “IT in health sector has linked district hospitals with tertiary level hospitals- planned in the 11th Plan. He also mentions that IDSP and NRHM have brought together use of IT and satellite communication for information flow, video conferencing, education and guidance and inventory and GIS, mapping of all government health facilities.”
Synergies for Long Term Gains through Health Insurance
The second session was a panel discussion moderated by Amod Kumar, PD, Manthan (MNH) Project, IntraHealth who believes that health insurance is a vibrant and expanding sector in India. The latest schemes such as Rashtriya Swasthya Bima Yojana (RSBY) and Aarogyasri are offered for uplifting rural health to improve health financing. RSBY is basically a programme initiated by Ministry of Labour Development, Government of India for rural families. The programme issues a card for the head of the family to get a health insurance with which they can be treated in the hospitals affiliated to the programme. Today mass coverage of BPL families is done by RSBY and the scheme has been very successful so far.
Dr Shreeraj Deshpande, Head â€“ Health Insurance, Future Generali India Insurance Co Ltd discussed his company’s role in synergising long term gains by creating insurance policies to deliver and upgrade healthcare services. Future Generali has 18 percent of share in the health insurance sector. The role of technology in insurance is used for distribution of health insurance, customer service and data flow and capture. For the rural population, they have incorporated web enabled common kiosks which are a single window concept for financial products.
He added, “The process of reimbursemet presently takes around 20 days and we plan to shorten it up to 3-4 days to hold the customers’ interest.” He also mentioned that the company focuses on web insurance of policies, web enrolment of members in corporate, eCards and eEnrolment of members and dependents, customers can access their policy coverage information online as well as seek information online.
He further elucidated, “Data transfer from insured to hospitals to TPAs/insurers save time and cost. Uniform billing patterns/uniform discharge card formats/uniform hospital records formats will facilitate immediate transfer of information. He concluded, “With such innovations and developments in the technology, we will have smooth electronic data flow from insured to insurer, diagnostic centre to insurer, hospital to TPA/Insurer and insurer to insured. It will help better fraud detection as well as fraud management.”
Anjana Agarwal, CIO, MAX Bupa discussed about Max Bupa and its role in leveraging better policies in health insurance systems. She stated that they were the first to have an integrated system which does not give space for any paper work. “As a philosophy, the company tries to set up services in house which is not being handled by the vendor including enrolment, claim processes and handling services or any queries. The way insurance is visualised, the planning for insurance is easily done by the urban population but that is least on the priority list. The populations still do not believe that it will be of any gain to them. Insurance provides an advantage and indirectly the insurers gain”, said Anjana Agarwal.
She concluded the session by mentioning that MAX Bupa are more of a wellness and a partner programme. They are trying to dwell from a reactive approach to a proactive approach.
Information and Communication Technologies for Achieving Millennium Development Goals in Healthcare
This session started with the discussion on role of ICT in achieving MDGs. Prof Maurice Mars, Prof of Telehealth, Dept of Telehealth, Nelson R Mandela School of Medicine, South Africa delivered the keynote address with focus on role of telemedicine in India and African countries.
He said, “People who need ICT live in the rural areas and at the bottom of the pyramid. According to WHO report 2006, Africa has 24 percent of the disease burden but only 3 percent of health workers command less than one percent of world health expenditure. Thirty oneÂ African countries have 10 doctors or fewer per 100,000 people whereas in India, there are 60 doctors per 100,000.”
He added, “Developed countries spend 2 â€“ 2.5 percent of their health budget on health ICT where as in US, it is US $ 55 per person and in Africa, it is US $ 0.70. Implementation of telemedicine in the developing countries face major problems related to high telecommunication costs, low internet penetration, lack of literacy and computer literacy and language.” Prof. Mars highlighted the role of private sector in facilitating the benefits of ICT in healthcare.
Gp Capt (Dr) Sanjeev Sood, Hospital & Health Systems Administrator SMC, Air Force Station, Chandigarh focused on MDGs. He said, “Benefits of ICT should be made available to the healthcare sector. Most sectors in general and healthcare in particular lag behind due to various barriers, such as, lack of resources and initial capital costs involved in implementation of technology projects.”
Dr Karanvir Singh, Consultant Surgeon and Head, Medical Informatics, Sir Ganga Ram Hospital delivered his presentation with focus on ICT in healthcare. He said, “Adverse incidents in hospitals compromises patient safety cost to the government reaching to billions of dollars each year.Â It has been the aim of every ‘medical organisation’ to improve its safety record. The ideal solution is to improve processes and ensure adherence to the extent that no care provider, in any situation, can cause a patient related adverse incident. Enterprise of wide computerisation can help to a certain extent in achieving this aim.”
Dr Neena Pahuja, CIO, Max Healthcare said, “In the recent past, there have been certain positive developments in this field that have provided the requisite impetus for much greater IT adoption in hospitals in India. Privatisation and corporatisation of hospitals coupled with growing awareness of the benefits of IT solutions is driving this trend.”
In this session Dr SB Gogia, Consultant Plastic Surgeon, Past President IAMI said, “Healthcare Informatics, is a resource organisation for Healthcare Information Technology (HIT), consisting of IT savvy doctors, community health specialists, IT personnel, telecommunications experts and sociologists. from Society for Administration of Telemedicine (SATHI) which has been involved in implementing the Healing Touch Project, which was sponsored by OXFAM Trust India. As project consultants our role was to pilot a sustainable telemedicine system which could also provide a roadmap for the future.”
Strategies for Developing and Implementing Telecommunication, Wireless and Mobile Healthcare Services
He said, “If we start creating hard infrastructure, we might build a few facilities in rural India; but for sure, we will not be able to maintain and sustain the hard infrastructure in rural India in the long run. Also, absenteeism of doctors will continue to be a perennial problem for rural India. According to Economic Survey 2009-10, only 13 percent of rural population has access to PHC and only 34 percent of rural population has access to diagnostic centers (CCF).”
He said, “It is a fact that has not been accepted by policy makers that it is nearly impossible under the current rural infrastructure and payment terms to get good doctors to work in rural India.Â Rural India needs to extensively leverage the 3 G and WIMAX technology and adopt preventive care model to avoid pain, suffering and high cost of healthcare.”
Dr BS Bedi, Advisor, Health Informatics, Centre for Development for Advanced Computing (CDAC) spoke about the innovations and implementation of ICT in healthcare.
He said, “The lack of information is now being planned and collected by the health information system. We are adding 18 million mobile handsets per month. Health delivery will go down right to the bottom of the pyramid with the help of mHealth.”
He added,”With introduction of computers and technology, the databases are now organised and created on computers at block level in specialised primary healthcare centres.”
PS Ramkumar, Scientific Expert-International Telecommunication Union, United Nations said, “In India, nearly 38 percent people cannot read/write and 8 percent of urban population is computer literate. We have to accelerate preventive care without waiting for the latest technologies. We should prioritise investment on alternative technologies based on care scenarios and enhance utilisation by launching graded e-Services in step with infrastructure roadmap.”
Initiatives and Developments in Medical Technologies and Clinical Diagnostics
Chaired by Dr Ashok Seth, Chairman, Cardiac Sciences, Fortis Escorts Heart Institute, the session ‘Initiatives and Developments in Medical Technologies and Clinical Diagnostics’ focused on the technological advancements that have transformed the way diagnosis and treatment are performed now-a-days.
Anil Swarup, Director General, Labour Welfare, Ministry of Labour and Employment, Government of India also participated in this session and gave a special talk on how RSBY, with the help of technology, has transformed the lives of millions of people living below the poverty line by providing them cashless and paperless health insurance.
Dr Ashok Seth kicked off the session by sharing insights into the revolutionary advancements that have taken place in the medical technology industry. He said, “The innovations, initiatives and enterprising solutions in terms of diagnosis, therapeutics and newer models of healthcare delivery have been reflected in the growth over the past two decades and the way healthcare is delivered, today.” Dr Harsh Mahajan, Honorary Radiologist to the President of India and Medical and Managing Director, Mahajan Imaging elucidated the role of digitisation in revolutionalising the field of radiology. “In past, taking scans and making films out of them was a huge task. Transferring these images from one place to another was also difficult and required a lot of time and effort. Today, with development of infrastructure and technology, capturing, storing and transferring images has become an easy task,” he said. Talking about the key challenges in clinical diagnostics, Dr SK Verma, Consultant and Head, Department of Clinical Biochemistry, Safdarjung Hospital said, “In the US, FDA approval is required for all diagnostic technologies. However, in India, there is no system for approval of any authority for producing diagnostic kits. Also, lack of enough research and development in the country restricts technology innovations and most of the technologies used in diagnostic labs are imported from outside.”
Explaining the role of information and communication technologies in enhancing patient care, Dr Ramachandra Lele, Director-Nuclear Medicine, Jaslok Hospital said, “Human memory based medicine is increasingly unreliable. ICT plays a crucial role in high quality healthcare and electronic medical records and computerised prescriptions are the essential ingredients for change.” Terming EMRs as the most potential change agents, he said, “We generate tremendous data in our clinical practice and EMRs can provide possibilities for research.” Dr Shakti Gupta, Head of Department, Hospital Administration and Medical Superintendent, AIIMS talked about technology for safe patient care in healthcare institutions. Talking about relevant technologies for patient safety, he said, “Computerised Physician Order Entry systems and Computerised Decision Support Systems can resolve the medication and human error issues to a large extent, thereby enhancing patient safety.” Dr OP Yadava, CEO, National Heart Institute differed from others and said, “Science and Technology has to develop in tandem with the society, therefore all international technologies and trends will necessarily not be effective in our country. As we develop technology, we must also evolve our human resources and get them on the same platform.”
Pointing out to the issue of high cost of technology, Dr Sanjeev Bagai, Sr Consultant Paediatrician & Nephrologist, Nephron Clinics & Edmed Healthcare said, “We are extremely fortunate to be practicing in an era cutting-edge technology. Even today, a routine protocol for screening all newborns for inborn errors of metabolism does not exist. The cost for screening a newborn is way beyond the reach of a common man.” Talking on IT implementation in labs, Dr Aparna Ahuja Lab Director, Gurgaon Reference Lab, SRL said, “At SRL, we have a homegrown information system called CLIMS, which is Clinical Lab Information Management System. Since SRL caters to various hospitals also, CLIMS can be easily integrated with the Hospital Information System of the hospital to ensure timely delivery of reports.” Elucidating the major challenge, Dr Punit Nigam Metropolis Healthcare said, “Technology itself is not the solution. How you adapt this technology and what you deliver is what matters.”
The session ended with an interesting talk by Rohit Kumar, Managing Director, Health Sciences, South Asia, Elsevier who focused on technology enabled medical literature and Elsevier’s role in publishing evidence based scientific literature with the who’s who of the world. “Elsevier has put a lot of its content online including articles that go back to the first issue of lancet.Â We are establishing a very strong and robust publishing programme for the Indian market and we are putting all content online in context of a global knowledge base.
Redefining Medical Education to Bridge the Rural-Urban Healthcare Divide
Rohit Kumar, Managing Director â€“ Health Sciences, South Asia, Elsevier, elucidated that the education system can be reformed by changing the way healthcare professionals access information in the field of medicine.
He further added, “We have been predominantly a rural population so we are rapidly urbanising the healthcare industry which is poised to grow about 21 percent by 2021. A lot of it will be fuelled by demographic changes and aspirational changes. On the down side, our healthcare spending is among the lowest in the world. People pay for healthcare services unlike other countries like Europe and UK where the government provides free healthcare. The latest MCI data shows about 40,000 seats this year and 23,000 seats for PG course. We are gradually improving but we do lack in the infrastructure in villages.”
Rohit Kumar concluded, “Our role is to make sure that we have localised content available as a publisher and make them available to the users. We are creating project MBBS consult which will train the faculty in the villages to customise knowledge effectively with the combination of animation, videos, graphics, simulations and assignments. We even have built a simulator rabbit online for medical students which will be launched soon. We will soon have evidence based scientific content online so that the students can get access to authentic information”.
Dr AK Agarwal, Professor, IGNOU School of Health Sciences, explained the need to encourage doctors to go to villages and treat the rural people. He believes that medical colleges train the students in a manner that they look forward to work in the metro cities. There are very few initiatives done to make the medical education appropriate and affordable to vast majority of population in the rural areas.
He said, “Medical education is skewed towards tertiary care and high-end technology in urban areas, neglecting the development in remote areas. We need to shift towards transformative learning to develop leadership qualities to produce enlightened change agents for medical education. Our doctors do well in the UK and USA because they have good systems. Medical education is one such area which needs better systems.”
Dr Vaidyanath Balasubramanyam, Domain Consultant, Medical E Learning, President, Bangalore, added, “If we do not have the right content for the right audience the whole exercise is meaningless.” He majorly focused on the content development and technology to reach the students. There are various ways to teach and learn concepts through flash animations and 3-D processes. There are three domains in medical technology, first is, disseminating through snapshots and pictures, second is applying knowledge into actual situational experiences such as virtual rabbit and third is skill development.
Dr SS Kulkarni, Advisor to various educational institutions, discussed about the mindset of developing educational institutions. He said, “In this urban civilisation, we see the urban doctors are not properly trained and the technological content is not available in the best of the colleges. The systems can only be implemented when there is a strong policy of the government and will of the people to work. We need to train the manpower in the education system as people lack faith in the doctors who are at the primary and secondary healthcare centers which draws them to tertiary healthcare providers leading to high cost of treatment.”
Dr TK Jena, Professor, IGNOU School of Health Sciences, said, “There are various challenges being faced by the people in the system which includes unwillingness of doctors, inadequate facilities and absence of referral system.” He added, “Rural areas are devoid of basic facilities like water, electricity, transport. There is no need of a demarcation or a divide between the rural and urban healthcare services.”
He concluded the session by addressing the solutions for overcoming challenges by redefining medical education for capacity building, expansion of utlisation of health infrastructure for medical education and developing district level hospitals as academic hubs, which holds the key to change in health scenario of the nation.