Information and Communication Technology ICT in Healthcare

Information & Communication
Technologies (ICT) in Healthcare
Presenter – Dr. Madhushree Acharya
Junior Resident
Preceptor – Dr. Arvind Kumar Singh1
Dr. Prem Sagar Panda2
1Assistant Professor , 2Senior Resident
Dept. of CM & FM,
AIIMS Bhubaneswar

Outline of the presentation
• What is Information & Communication Technology (ICT)?
• Need of ICT in healthcare
• Constraints of implementation of ICT
• Implementation of ICT in various countries & India
• Various ICT initiatives taken in India

What is Information & Communication Technology?
• Application of computers and telecommunication equipments in healthcare
• To store, retrieve, and share health care information electronically for
communication and decision making.
• It will improve overall quality, safety and efficiency of the health delivery system
• Worldwide use of computer technology in medicine began in early 1950’s.
Source- https://www.asianhhm.com/articles/role-information-technology-medical-sciences/

Need of ICT in healthcare - Benefits
• Delivering quality health care
• Accessibilty of services to remote areas
• Increasing workflow efficiency
• Reduce healthcare costs
• Patient safety- reduce prescription errors
• Clinical decision making
• Training and education of health workers
• Health promotion – knowledge sharing
with general public
• Feedback - improve services

Constraints of implementation of ICT
• Inadequate health infrastructure
• Insufficient access to internet by majority of population ( rural )
• Lack of requisite skills to use them
• Poor resource allocation
• Lack of comprehensive policy on ICT – absence of standards, guidelines, quality
control mechanism
Source- Information and communication technologies and health in low income countries: the potential and the constraints.
C. P. Chandrasekhar and J. Ghosh PMCID: PMC2566653

Implementation of ICT in various countries
• Highest number of applications : North America> Europe >Asia >Africa> Australia>
Middle East> South America
• Health problems : diabetes > obesity > CVDs > HIV > mental health > health behaviors>
maternal and child's health> cancer> family health planning> TB > malaria> COPD> vision
care > skin
• Most applications fell in the areas of health monitoring and surveillance> health
promotion and raising awareness > communication and reporting> data collection>
telemedicine> emergency medical care> point of care support and decision support.
Source : mHealth Application Areas and Technology Combinations*. A Comparison of Literature from High and Low/Middle Income Countries.
(2017 Aug 8;56(7):e105-e122. doi: 10.3414/ME17-05-0003)

• Most solutions used: SMS/mobile apps > IVRS > website/email >
videoconferencing/video/voice messages.
• SMS and app solutions are the most common forms of mHealth applications.
• SMS solutions are prevalent in both high and LMICs while app solutions are
mostly used in high income countries.
• Common application areas include health promotion and raising awareness
using SMS and health monitoring and surveillance using mobile apps.
• Diabetes is the most commonly targeted medical condition.
Source : mHealth Application Areas and Technology Combinations*. A Comparison of Literature from High and Low/Middle
Income Countries. (2017 Aug 8;56(7):e105-e122. doi: 10.3414/ME17-05-0003)
Implementation of ICT in various countries

Implementation of ICT in India
• India is a hub for IT enabled industries, yet use of HIT is very less in India.
• It has been mainly used by big pharma companies and private health sector like
corporate hospitals.
• Public health sector lacks behind in its utilization.
• In past decade, health insurance which uses IT has grown very rapidly.
• Currently ICT is being used in Electronic Health Records (EHR), Telemedicine,
Digital medical library, Hospital information management system, e-learning
technologies, public health informatics etc.
Source- Health IT in Indian Healthcare System: A New Initiative [Research Journal of Recent Sciences; Vol.1(6),83-
86,June(2012)]

• Digital health has huge potential of improving the healthcare delivery system.
• Ministry of Health & Family Welfare has undertaken various initiatives using
Information & Communication Technologies (ICT) for improving efficiency &
effectiveness of the public healthcare system under the overall objective of Digital
India.
• Ministry is continuously working on planning and introducing more of ICT initiatives.
Implementation of ICT in India

ICT initiatives taken in India
• The ICT initiatives by Ministry are briefed under following categories:
I. Online Services
II. Mobile applications
III. Service delivery and tracking
IV. Process automation
V. MIS and Surveillance
VI. Standards and Regulations
VII. Capacity building
VIII. Online consultation -
TeleMedicine
Source: https://mohfw.gov.in/about-us/departments/departments-health-and-family-welfare/e-health-
telemedicine/e-governance

I. Online Services
1. National Health Portal
2. Online Registration System (ORS)
3. ‘ Mera Aspataal ’ ( Patient Feedback) Application
4. Central Drugs Standards Control Organisation “ SUGAM ”
5. Food Safety and Standards Authority of India (FSSAI)
6. National Organ & Tissue Transplant Organisation (NOTTO)

1. National Health Portal
• Citizen Portal for Healthcare
• Provides Health related information
to citizens and stakeholders
• in 6 different languages – Hindi,
English, Tamil, Gujarati, Bengali,
Punjabi
• Website: http://www.nhp.gov.in

2. Online Registration System (ORS)
• ORS under e-Hospital application
• Launched under Digital India programme in
July 2015
• Common platform for online registration to
various hospitals, appointment, viewing lab
reports, blood availability status etc.
• 130 hospitals are on board (All AIIMS, RML,
Safdarjung hospital, NIMHANS, JIPMER etc.)
• Website:http://www.ors.gov.in/

3. “Mera Aspataal”
• empower citizens to participate in improvement of healthcare service delivery
• IT based feedback system to collect information on patients’ level of
satisfaction on service quality, facilities etc. at hospitals
• using a multi-channel approach viz. SMS, Outbound Dialing, Web Portal, and
Mobile App
• To help the government to take appropriate decisions for enhancing the quality
of healthcare delivery across public facilities
• Website: http://meraaspataal.nhp.gov.in/

Mera Aspataal Mobile App
• The application
allows feedback to
be consolidated,
analysed and
disseminated on a
frequently
updated
dashboard.
• Launched- August,
2016

4. “SUGAM”
• Central Drugs Standards Control Organisation
“SUGAM”
• “single window” for multiple stakeholders
(Pharma Industry, Regulators, Citizens)
involved in the processes of Central Drugs
Standards Control Organisation
• “SUGAM” enables online submission of
applications, their tracking, processing &
grant of approvals online mainly for drugs,
clinical trials, ethics committee, medical
devices, vaccines and cosmetics.
• Website: http://www.cdsco.nic.in/

• Vision : To protect and promote
public health in India
• Mission: To safeguard and
enhance public health by assuring
safety, efficacy and quality of
drugs, cosmetics and medical
devices
SUGAM

5. FSSAI
• Food Safety and Standards
Authority of India
• For ease of services to food sector
stakeholders
• services : Online License,
Clearance, Product approval to the
Food Business Operators.
Website: http://www.fssai.gov.in/

6. NOTTO
• To promote organ donation amongst
citizens at large
• National Organ & Tissue Transplant
Organisation through its web-portal offers
services
• Online Registration for Organ/Tissue
Transplantation or Retrieval and Online
pledge registry by citizen for organ
donation.
Website: http://www.notto.nic.in/

II. Mobile Applications
i) Vaccine Tracker ( Indradhanush Immunization)
ii) India fights Dengue
iii) NHP Swasth Bharat
iv) NHP Directory Services
v) No more Tension Mobile App
vi) Pradhan Mantri Surakshit Matritva Abhiyan Mobile App
vii) Mera Aspataal Mobile App

i) Vaccine Tracker ( NHP Indradhanush )
• support parents in tracking
immunization status of their
children upto 16 years age
and helps them in ensuring
complete and timely
vaccination.
• Launched- April, 2016
• Available on Google Play
• Website http://www.nhp.gov.in/nhp-
indradhanush_pg

• The vaccine schedule is configured automatically by providing the date of birth of the child.
• A user can register any number of children for which he/she would like to get vaccination alerts.
• The user can also add any other vaccine, if recommended by the physician, to the reminder list.
• The “NHP Indradhanush” is an Android based mobile application, which can be installed on any
device with Android OS version 2.3 or above.

ii) India fights Dengue
• Enables a user to
check Dengue
Symptoms, get
nearest Hospital /
Blood bank
information and also
share feedback
• Launched- April, 2016

iii) NHP Swasth Bharat
• information
dissemination on
Disease, Lifestyle,
First Aid
• Launched- April,
2016
• Website -
http://www.nhp.gov.in/nhp
-swasth-bharat_pg

NHP Swasth Bharat
• User location (GPS) needs to
be enabled for the app to
function
• The user has the option of
accessing the list of hospital/
blood banks by selecting the
minimum distance of 5Kms
and maximum distance up to
100Kms from the current
location.

iv) NHP Directory Services
• NHP Directory
Services Mobile App. -
provides information
related to Hospitals
across India
• Launched- June, 2015
• Website -
http://www.nhp.gov.in/nhp-
health-directory-services-
mobile-application_pg

v) No More Tension Mobile App
• Stress affects
physical & mental
health
• information on
stress management
related aspects
• also helps you to
know your stress
levels and how to
reduce them.
• Launched-
November, 2016
• Website-
https://www.nhp.gov.in/mob
ile-no-more-tension
• Stress Meter, calculates stress level of an individual, based on a questionnaire,
and based on their score would advise them the steps they should incorporate
in their life in order to avoid stress.
• The application also has a music option from which a user can select different
type of music as per their mood.

vi) Pradhan Mantri Surakshit Matritva Abhiyan
Mobile App
• for reporting pregnancy care
related information from across
states
• for registration of private/
voluntary/retired obstetricians,
radiologists and physicians willing
to provide free antenatal services
to pregnant women at
Government Health Facilities on
9 th of every month.
• platform for receiving patient
feedback and creative
suggestions
• Launched- November, 2016
• Website -https://www.nhp.gov.in/mobile-pmsma

III. Service delivery & Tracking
A. Mother and Child Tracking System (MCTS)
B. Kilkari
C. Nikshay
D. m-Cessation (Tobacco Cessation programme)
E. m-Diabetes programme

A. Mother and Child Tracking System
• an individual-based tracking system
implemented across all the States & UTs to
facilitate timely delivery of antenatal and
postnatal care services and immunization to
children
• objective of improving IMR, MMR, &
morbidity
• providing alerts to health service providers
about the services due list and service
delivery gaps
• appropriate health promotion messages to
beneficiaries.
• Currently over 12 crore pregnant women
and around 11 crore children have been
registered on MCTS / RCH portal since
inception.
Website: http://www.rch.nhm.gov.in/RCH/

B. Kilkari
• Kilkari = Baby’s gaggle
• It delivers free, weekly, time-appropriate 72 audio
messages about pregnancy, child birth and child
care delivery to families’ mobile phones.
• Approximately 6 crore successful calls have been
made so far under Kilkari in Bihar, Chhattisgarh,
Haryana, Himachal Pradesh, Jharkhand, Madhya
Pradesh, Odisha, Rajasthan, Uttar Pradesh and
Uttarakhand.
• Toll free number: 1800-3010-1703

C. Nikshay
• Ni= no ; kshay= wasting (TB)
• TB patient monitoring system
• tracking of individuals for treatment-
adherence has been implemented across all
States.
• Also a Missed Call Centre facility with Toll
Free No: 1800-11-6666 for reaching to
unreached TB patients is available, for
counselling and treatment support.
• Approximately 80 lakh patients have been
registered on Nikshay.

D. m-cessation
• mobile-based interventional
initiative for counselling and
helping people to quit tobacco,
by giving a missed call to 011-
22901701.
• Currently over 20 lakhs total
missed calls have been
captured and around 15 lakhs
users are registered for this
programme.
• Website: http://www.nhp.gov.in/quit-
tobacco
• Content adaptation and web-based messaging were developed
by Centre for Addiction Medicine, National Institute of Mental
Health and Neuro Sciences (NIMHANS), Bangalore.

E. m-Diabetes programme
• mobile-based initiative for
prevention and care of
diabetes by giving a missed
call to 011-22901701.
• Currently more than 1 lakh
users are registered for
mDiabetes
• Website: http://mdiabetes.nhp.gov.in/

IV. Process Automation
a. Hospital Information System
b. ANMOL
c. Drugs & Vaccines Distribution Management System ( e-Aushadhi)
d. e-Rakt Kosh

a. Hospital Information System ( HIS )
• for automation of hospital processes to achieve better efficiency and
service delivery in Public Health facilities upto CHC level.
• Key implementation milestones include:
• a) e-Hospital developed by NIC has been implemented on cloud platform in
over 100 hospitals as on date and more than 50 hospitals are on standalone
platform
• b) e-Sushrut application of C-DAC Noida has been Functional in Rajasthan
(State-wide: 80 facilities) & 15 hospitals
in other states

b. ANM on Line ( ANMOL )
• A tablet based application for Integrated
RCH Register which allows ANMs to
enter and update data for beneficiaries
of their jurisdiction
• piloted in the State of Andhra Pradesh
• currently around 15,000 ANMs are
working on ANMOL in Andhra
Pradesh and pilot districts of MP &
Telangana

c. e-Aushadhi
• Drugs & vaccines distribution management
system
• deals with purchase, inventory management and
distribution of various drugs, sutures and surgical
items to various District Drug Warehouses of
State / UT, District Hospitals (DH), their sub stores
at CHC, PHC
• DVDMS has been implemented so far in 9
States/UTs – Andhra Pradesh, Gujarat, Jammu &
Kashmir, Madhya Pradesh, Maharashtra, Odisha,
Punjab, Rajasthan
• also implemented in Central Medical Services
Society (CMSS) - a Central Procurement Agency
under Department of Health & Family Welfare

d. e-Rakt Kosh
• centralised blood bank management
system with the help of online systems
• all the licensed blood banks in public and
private health facilities in States / UTs.
• eRakt Kosh is online in 7 Blood Bank in
Delhi, Madhya Pradesh, Uttarakhand and
Uttar Pradesh.
• Around 124 Blood Banks are registered on
e-RaktKosh Portal for Blood Stock
Updation.
• 2 blood banks in Uttarakhand, 1 in UP & 1
in West Bengal are in process of using the
application.
• Website: http://www.eraktkosh.in/

V. MIS & Surveillance
1) Health Management Information System ( HMIS )
2) Integrated Disease Surveillance Programme ( IDSP )
3) Central Dashboard

1) Health Management Information System
• HMIS is a web based portal for
monitoring the programmes under
National Health Mission (NHM).
• For monthly service delivery data
reporting from public health
facilities to improve program
monitoring and management.
• Approximately 2 lakhs Health
facilities are regularly reporting on
HMIS Portal.
• It is integrated with GIS and
available in public domain.
• Website: https://nrhm-mis.nic.in/

2) Integrated Disease Surveillance Programme
(IDSP)
• Online portal for data entry,
reports, data analysis, training
modules
• Approx. 90% districts report
weekly surveillance data
through portal.
• There is also a 24x7 call centre
for disease alerts on a toll free
number; for verification and
initiating appropriate action
• Website: http://idsp.nic.in/

3) Central Dashboard
• monitoring of key indicators
related to different health
programmes of the Ministry.
• Dashboard system collects data
from existing public health
information systems (i.e. HMIS,
IDSP, MCTS, Nikshay, etc)
• The Dashboard system help in
analysing/ measuring progress on
newer healthcare initiatives of
MoHFW, Government of India

VI. Standards & Regulations
1. National Digital Health Authority
2. Electronic Health Records ( EHR ) Standards
3. National Resource Centre for EHR Standards
4. National Identification Number ( NIN )

1. National Digital Health Authority
• NDHA is being set up by MoHFW as nodal agency for formulation,
adoption & regulation of eHealth Standards in India
• nodal agency for all strategic eHealth initiatives in India.
• The Act for setting up of NDHA has been drafted and is under approval
process to be placed in public domain for suggestions and comments.

2. EHR Standards
• modified in December 2016.
• The EHR Standards include standards for Disease
Classification, Medicine and Clinical terminology
(SNOMED-CT), Laboratory Data exchange, Digital
Imaging and Communication (DICOM) etc. for
semantic interoperability.
Website : http://mohfw.nic.in/sites/default/files/17739294021483341357_1.pdf

3. National Resource Centre for EHR
Standards
• NRCeS is set up in order to augment
facilitation for adoption of the notified
EHR Standards in technical association
with C-DAC, Pune for providing assistance
in developing, implementing and using
EHR standards effectively in healthcare IT
applications in India.
• Website link: http://snomedctnrc.in/

4. National Identification Number
• A unique identification number, which a key requirement for achieving inter-
operability and creation of EHRs, is being assigned to all health facilities (both public
& private) to facilitate inter-operability among health IT systems deployed.
• More than 2 lakh Public Health Facilities have been allocated NIN.
• The process for setting up mechanism for allocating NIN to private facilities is
underway.
• Website: http://nin.nhp.gov.in

VII. Capacity Building
A. Mobile Academy
B. Training Management Information System ( TMIS )

A. Mobile Academy
• It is a free audio training course
• designed to expand and refresh the knowledge
base of ASHAs and improve their
communication skills
• Launched in 2016
• A total of over 70000 ASHAs have completed
the Mobile Academy course since inception in
Bihar, Chattisgarh, Himachal Pradesh,
Jharkhand, Madhya Pradesh, Rajasthan and
Uttarakhand.

VIII. Online Consultation - TeleMedicine
Tele-health solutions are being promoted to deliver basic and
specialized health care services nearest to the end user in inaccessible
and rural areas.
The key initiatives include :
1. National Medical College Network ( NMCN )
2. National TeleMedicine Network ( NTN )
3. Establishment of SATCOM based Telemedicine Nodes

1. National Medical College Network
• About 50 Govt. Medical Colleges are being inter-linked
utilising the connectivity provided by National Knowledge Network
• Tele-education, e-Learning
• Digital medical library
• Digital diagnostic services
• Online Medical Consultation by a virtual layer of Specialty/
Super Specialty doctors from these Medical colleges to citizens through web
portal
• help patients from rural, remote and urban areas to access doctors and
specialists easily even from their home location through their Smart
Phones, through Government healthcare institutions (PHC/CHC) and
through Common Service Centers (CSCs)

2. National Telemedicine Network
• Online medical consultation- by
specialist doctors
• Virtual opd – at remote areas
• In phase I of National Telemedicine
Network project -proposed to connect
500 PHC/CHC/SDH at remote locations
with 100 District Hospitals and 50
Medical Colleges.
• Telemedicine network needs to be
promoted and strengthened under
Programme Implementation Plan of
NHM

3. Establishment of SATCOM based
Telemedicine Nodes
• Satellite communication based Telemedicine nodes and
Mobile Telemedicine Units at various unreachable
geographical locations
• Mass screening of non-communicable disease (NCD), health
awareness and for providing specialty consultation
• Tele-health services in field of medicine, orthopedics,
respiratory and cardiology disciplines
• Undertaken by Dept of Space (DoS) through ISRO

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