Telemedicine - Improving public health through ICT : November December 2006 Issue

A bi-monthly magazine on ICT and Health

Vol. 1 No.1

November-December 2006

www.eHealthonline.org

Telemedicine Improving public health through ICT

ICT for rural healthcare - The teleclinic way Page 6

e-Health and the healthcare system Page 16

Future of e-Health in India is bright Page 33

We build

We explore

Documentation We search

We capture We cooperate We advocate

Discussion

We converse We inform

We collaborate

We share

Dissemination

We interact We deliver

We propagate We serve

We reach out to communities

We bring change for progress www.digitalLEARNING.in

Contents Cover Story

6

ICT for rural healthcare- The Teleclinics way Toms K. Thomas

11

GIS and Telemedicine: Tools for Public Healthcare Nidhi Dani, Sanjay P. Sood, Prof. Nupur Prakash, Prof. Victor Mbarika and Rajeev Agrawal

Perspective

16

e-Health and the Healthcare System

23

Moving beyond hospitals: e-Prescriptions

Denise Silber

Pushwaz Virk and David W. Bates

Interview

33

Future of e-Health in India is bright Interview with Dr. Shashi Gogia

Case Study

28

e.Health.Net: ICT at government health institutions Ghan Shyam Bansal, Dr. Ravinder Goel, S. S. Duggal, Rahul Jain and Anil Aggarwal

News

26 35

Business World

November - December 2006 | www.eHealthonline.org

Project Showcase

38

@HEALTH - Project for international cooperation 3

Editorial Guidelines Contributions to eHealth magazine could be in the form of articles, case studies, book reviews, event report and news related to e-Health projects and initiatives, which are of immense value for practitioners, professionals, corporate and academicians.

We would like the contributors to follow these guidelines, while submitting their material for publication: • Articles/ case studies should not exceed 2500 words. For book reviews and event reports, the word limit is 800.

• An abstract of the article/case study not exceeding 200 words should be submitted along with the article/case study.

• All articles/ case studies should provide proper references. Authors should give in writing stating that the work is new and has not been published in any form so far.

• Book reviews should include details of the book like the title, name of the author(s), publisher, year of publication, price and number of pages and also have the cover photograph of the book in JPEG/TIFF (resolution 300 dpi).

• Book reviews of books on e-Health related themes, published from year 2002 onwards, are preferable.

In case of website, provide the URL. • The manuscripts should be typed in a standard printable font (Times New Roman 12 font size, titles in bold) and submitted either through mail or post.

• Relevant figures of adequate quality (300 dpi) should be submitted in JPEG/ TIFF format.

• A brief bio-data and passport size photograph(s) of the author(s) must be enclosed.

• All contributions are subject to approval by the publisher.

Log on to www.ehealthonline.org for goings-on in the world of eHealth 4

eHealth | November - December 2006

Editorial Vol. I, Issue 1

Nov-Dec 2006

Are you feeling feverish again?

Malaria, HIV-AIDS, Diarrohea, basic maternal and infant health related problems abound the world and happen to be killer diseases, threatening the very development prospects for many nations. The poor suffer the most due to lack of adequate healthcare infrastructure or access.

In developing countries, one child in eleven dies before its fifth birthday, compared with one in 143 in highincome countries. Every year more than 500,000 women die from complications of pregnancy and childbirth.

As per William Haiao (author of ‘Unmet Health Needs of Two Billion’, 2001) there are more than 2 billion peasants and ghetto dwellers in low and middle-income countries who are extremely poor.

At the same time, science and technology have made great strides in improving lives and livelihoods and made it possible for the best health care to save lives, improve life-spans and create productive manpower, the biggest asset for any economic development. Information Technology (IT) is another revolution in the making, providing opportunities to access expertise from around the world. This domain is hot again!

For example, the IT industry in India which ran through the dot.com fever 5 years back and then caught a cold, is back into action! Everyone, from the retail to real estate paanwala to the rickshawallah is thinking IT through Internet or a mobile! In these feverish seasons there are some people left out in the cold, it seems!

And that’s the health sector. There is no denying the fact that per capita availability of malls is going to be much higher than access to functional hospitals in the country! Indian poor spend the highest on health and get the lowest return on their investment. There are virtually no health insurance schemes available for the poor it is they who suffer the most from the inadequate availability of health infrastructure in the country.

While India is abuzz with the e-Governance plans of various sizes and shapes dotting all over the country, there seems to be a lack of ‘BIG’ initiatives in the e-Health sector at the national level.

What the exciting examples that can create an impact? Who are the stakeholders who have invested in this domain? How can we advocate for national scale thinking and implementation? How can we bring in corporations to chip in to contribute their bit? Keeping this in mind, we have embarked on the venture of creating awareness on e-Health issues and opportunities. These issues are relevant not only for India but also for several other developing countries in Asia and beyond.

We look forward to forging a community of practice in the e-Health sector through this print publication eHealth, through the online portal on this subject, www.ehealthonline.org and also through the conference eHealth Asia 2007 being held in Kuala Lumpur on 6 – 8 February 2007.

We are looking forward to your support and encouragement in this endeavour!

Ravi Gupta Ravi.Gupta@eHealthonline.org President Dr. M P Narayanan Editor-in-Chief Ravi Gupta Sr. Sub Editor Prachi Shirur Research Associate Sanjeev Kumar Shrivastav Designed by Bishwajeet Kumar Singh

Web Zia Salahuddin Ramakant Sahu Sales Gautam Navin +91-9818125257 Printed by Yashi Media Works Pvt Ltd New Delhi, India

Editorial and marketing correspondence eHealth G-4 Sector 39 NOIDA 201301, India Tel: +91 120 2502181-85 Fax: +91 120 2500060 Email: info@eHealthonline.org

eHealth does not neccesarily subscribe to the views expressed in this publication. All views expressed in the magazine are those of the contributors. eHealth is not responsible or accountable for any loss incurred, directly or indirectly as a result of the information provided. eHealth is a joint publication of Centre for Science, Development and Media Studies (CSDMS, www.csdms.in) and elets Technomedia Pvt. Ltd. (www.elets.in). © Centre for Science, Development and Media Studies and eLets Technomedia Pvt. Ltd. knowledge for change

Cover Story

ICT FOR RURAL HEALTHCARE: THE TELE-CLINICS WAY

H

ealthcare service is one of the important basic needs. Ill health could affect the living standards directly and indirectly. Healthcare service in the rural areas where more than 70 % of Indians live, is abhorrently inadequate.

Bundelkhand region in Central India, which includes districts of Madhya Pradesh and Uttar Pradesh, is the most backward region in India with a lack of proper healthcare infrastructure. A majority of sickness in Bundelkhand villages is treated by untrained personnel.

This is a general phenomenon in many of the villages in rural Madhya Pradesh (M.P.) and Uttar Pradesh (U.P.). It is a dichotomy to see an overwhelming of highly technology based hospitals and dispensaries in urban areas while the rural villages do not even have basic minimum public health facilities. Even within cities the poor do not have access to high tech healthcare facilities because of various reasons, mainly financial limitations.

Many of the public healthcare services like Public Health Centres (PHCs) and sub-centres in rural areas are not equipped and staffed to provide quality healthcare to the rural poor. This suggests the yawning divide between rural and urban healthcare services, between the rural poor and the well off. The new developments in healthcare have not percolated to the rural

6

areas and this is a matter of great concern.

While public healthcare system in India has the best professionals and one of the best systems (decentralized up to the sub centre level) there is a need to explore the ways and means to bring equity in access to health professionals and institutions.

This article is an overview of the healthcare services in the rural villages in Bundelkhand. The lacuna in the public healthcare delivery system in the poorest regions of M.P has been examined. It further suggests how the rural healthcare service delivery could be improved through the use of Information and Communication Technologies (ICT) with the example of the Tele-clinics of the Christian Hospital, Chhatarpur (a member of Emmanuel Hospital Association), where telephones are used to provide access to quality health (information and care). Tele-clinic is a pioneering healthcare service delivery project that addresses the health needs of the rural poor with the use of Information Technology.

ICT has a lot to offer in bringing equity in service provision through innovative programmes which bring the poor closer to the health professionals and institutions. Tele-clinic of Christian Hospital, Chhatarpur (Bundelkhand, India) is one of the examples where ICT is explored as a means to ensure better access to both health professionals and the rural poor

Cost of ill health Ill health is one of the major maladies that affect the livelihood and welfare of the poor. Hence policies that protect the health of the poor are critical in ensuring their well-being. Inadequate public health and safety measures could result in the inability

Toms K. Thomas Sr. Manager - Planning, Research, Monitoring & Evaluation & Freelance Development Practitioner, Evangelical Social Action Forum (ESAF), Kerala, India toms_thomas@yahoo.com

eHealth | November - December 2006

Table-1 Health infrastructure availability per 1000 square kilometres (1993)

State M.P U.P Kerala

Hospital .08 .25 5.28

Dispensaries .08 .59 4.5

PHC .27 1.05 2.28

Source: South India Human Development Report 2003, North India Human Development Report 2003, NCAER

of the poor citizens in investing their entitlement reserves for economic reproduction.

The use of entitlements to meet consumption needs could affect a family’s reserves negatively in the long run and could affect the ability of a family to face uncertainties. Though it is encouraging to note that some efforts are made to provide social protection to the poor through health insurance policies offered (public private partnerships) by some corporate insurance companies (even though a result of operational compulsion by government) and some state governments, these schemes are yet to reach the majority living in the rural areas. Health status affects human development in many ways. According to the Noble Laureate Prof. Amaratya Sen, health is one of the important human capabilities, which determine access to wealth.

Rural healthcare in Bundelkhand – Current scenario The public healthcare in Bundelkhand has the following challenges; a) Healthcare Access b) Healthcare Quality c) Healthcare Cost a) Healthcare access When people become ill, low-income households in rural areas continue to use home remedies, consult traditional healers and local providers who are often outside

the formal healthcare system. Men have comparatively better access than women to healthcare options at all levels due to various socio-economic and cultural factors (including their easy mobility). The bicycle is the usual means of transport in rural villages and riding a bicycle by women is not a normal practice in rural communities. It is also important to say that a sick man is better attended than a sick woman.

Poor women are most vulnerable to diseases and ill health as they live in unhygienic conditions, carry heavy child bearing burden, place little emphasis on their own healthcare needs, and encounter severe constraints in seeking healthcare for themselves. Table 1 suggests the status of health infrastructure in three states in India, which also include figures for M.P. It suggests that the state of M.P. is very poor in health infrastructure availability. For example the PHC available per thousand square kilometer is 0.27, which is far below the developed state of Kerala (average 2.28). The districts in Bundelkhand has the worst healthcare facilities. This calls for an urgency in rural healthcare provision. b) Healthcare quality Numerous studies have indicated that the healthcare facilities at Primary Health Centre (PHC)and Sub Centre levels are mostly understaffed and short of drugs and essential supplies and that they sometimes suffer from low staff morale and motivation. The quality of healthcare in

Table - 2 Availability of doctors and nurses per 100,000 population (1993)

State

Doctors

Nurses

M.P U.P Kerala

14.1 6.0 54.6

18.6 8.1 141.3

% of Births attended by Trained Personnel 22.1 26.6 87.4

Source: South India Human Development Report 2003, North India Human Development Report 2003, NCAER

November - December 2006 | www.eHealthonline.org

the rural and urban areas also differ. While the urban localities have healthcare options from five star medical colleges to small private dispensaries run by trained doctors, the rural areas often are left with the only option of untrained private practitioners. Table 2 suggests the availability of health care personnel in M.P., U.P. and points to the fact that the number of medical professionals available in M.P. is far inadequate as compared to Kerala. It also shows that a significant number of the deliveries in these states are conducted by untrained (traditional) practitioners. This to a large extent affects the quality of maternity care and impacts maternal mortality rates. c) Healthcare cost Providing healthcare services to the poor at a reasonable cost requires a significant amount of subsidy, either through government or non-government source. The study of many of the health insurance schemes implemented in Africa, Asia and Latin America points to this conclusion (Community Health Fund Tanzania and Nkoranza Community Financing Health Insurance Scheme, Ghana are some of the examples). Moreover, access needs to look into other viable and cost effective alternatives.

Thus, an assessment of healthcare facilities available for the rural poor in Bundelkhand suggests the following: • The health status in Bundelkhand villages in general is inadequate and does not comply even with the minimum public health requirements.

• The main healthcare providers for more than 80% population living in rural Bundelkhand are untrained private ‘practitioners’.

• The government PHCs are not regular and are not efficient in accomplishing its mission of facilitating quality medical outreach to the poor in the rural localities, both due to poor infrastructure, equipments and inadequate personnel.

• Emergency healthcare services are almost nil in rural areas. Accessing health services at odd times is a

7

Herculean task for the people in rural areas.

ICT kiosks and public health Information and communication technology has a very important role to play in facilitating quality healthcare to the rural poor in a cost effective manner. In an age of high-tech medical care, those excluded from the mainstream healthcare service could be provided with the benefits of medical professionals through the use of an appropriate ICT kiosk. This needs a joint commitment from both private and public sector.

Telemedicine is used as a means to provide health access to people world wide through the use of various kiosks. However, this has not become popular among the rural poor because of inadequate knowhow on the use of various kiosks. The countries in Asia have less than 10 % Internet users and less than 20 % telephone users in their rural localities, while in India the use of Internet in rural areas is less than 1%. In a situation where large-scale technology illiteracy exists, it is important to promote appropriate technology kiosks that would be easy for the poor to use.

Use of telephones could be a starting point for rural areas. Even operation of a telephone is complicated for many living in rural areas.

Tele-clinic Project of Christian Hospital is an example where a telephone is used to give access to quality medical care. Health workers are trained to make the communication more qualitative to enable the doctor to better diagnose and advise treatment.

Tele-clinics – Combination of ICT and social protection Tele-clinic initiated by Christian Hospital in Bundelkhand is one of the innovative mixtures of technology and health protection supplement. It is an attempt to introduce ICT in healthcare to improve the access to specialty care to those living in remote rural areas. The communication between a doctor and a patient is enabled through the use of a telephone.

8

Tele-clinic is a telephone enabled closed network of rural people, trained health workers and medical professionals of Christian Hospital. This network enables communication between doctor and a patient in a remote rural village with the help of a telephone. A trained health worker facilitates the communication between a doctor and a patient through a WLL phone provided by the BSNL (government owned telecommunication agency).

A trained health worker is recruited in

Aim: Develop healthy and economically productive rural citizenship through facilitating affordable, reliable and high quality health information to the rural poor using ICT. Objectives: • To provide emergency healthcare to the rural poor • To ensure safe delivery and motherhood in rural areas • To provide access to health information and making healthcare accessible to the poor.

Tele-Clinic Components

all the call centres. These call centres provide services like primary healthcare, ambulance service, telephone consultation, emergency drugs and so on. One call centre covers three to five surrounding villages.

Tele-clinic – Aims and objectives The above mentioned project is innovative and is a first with this unique combination in the whole world, especially in India. It is a combination of financial protection and healthcare access. The main goals and objectives of Tele-clinic are as follows.

• To facilitate quality medical care to the poor in remote rural villages.

• To provide public health safety net to the rural poor.

Tele-clinic components 1. Village Call Centres: Call centres are a very important component of the Tele- clinic. These centres are established in the villages where Teleclinic project is initiated. The centre is currently running in a rented room in the village. A trained health worker mans the call centres. The health worker is called Tele-health Worker

Network between call centre and hospital – use of ambulance. eHealth | November - December 2006

Tele-clinic – Levels of treatment Tele-clinic uses a three tier healthcare service through use of Information and Communication Technology (at present telephone is being used) a) Call Centre level – primary care manned by a health worker: b) Weekly referral clinics at Call Centre Level – Manned by nurse & laboratory technician c) Hospital level – secondary care At all these levels the consultation of a qualified practitioner / a specialist is important. All treatments are provided after specialist consultation over phone, except in case of causalities where health worker administer emergency drugs / refer the patient to the hospital.

Tele-clinic - Value addition in rural healthcare Call Centre Structure

(THW), who is provided with a telephone, basic diagnostic equipments and emergency drugs. All the health workers are trained by St. Johns Ambulance Service and Comprehensive Rural Health Project Jamkhed (Maharashtra). Call centres provide the following main services: a) Telephone consultation with a doctor at Christian Hospital b) Emergency drugs c) Clinical support through nurse-runclinics d) Health awareness through periodical campaigns 2. Ambulance Service: A round the clock ambulance service has been started by the Tele-clinic Project to provide access to the hospitals. A separate phone number is given to access the ambulance and this service is available any time of the day or night. Further, this service could be used to visit any hospital in the town at times of emergency. The following figure shows the same.

3. Medical Assistance Plan (MAP): Medical assistance plan is similar to a November - December 2006 | www.eHealthonline.org

health insurance and is an important component of Tele-clinic Project. Those who are in MAP pay an advance membership fee to avail medical (Inpatient and Out-patient) facilities at the Christian Hospital, at a prefixed rate.

MAP has membership fee ranging from USD 1.33 to USD 12.79 with coverage of USD 22.25 to USD 222.45.

Currently there are around 50 villages covered through 15 different call centres.

One call centre serves 4 to 6 villages. The population per call centre ranges from 3000 – 10000. The current MAP membership varies from 100 to 250 per call centre. There are a total of more than 1500 members enrolled in this scheme. The project currently serves a total population of 30,000. All the target villages are at very remote locations and are away from the main road. While selecting a village access is one of the important criteria. Those villages with minimum access are selected because it would help in effective implementation of the project. Figure titled call centre structure shows the network of call centres, villages and the hospitals.

• Promotion of good practices in healthcare in rural areas: There is a remarkable change in the practices related to healthcare in the villages after the introduction of Tele-clinics. Many of the members enrolled in MAP have never been to a qualified practitioner / a hospital. The poor people buying this new idea is an indication of their change in attitude towards healthcare.

• Improved access to specialists through a telecommunication network: Teleclinic wherever established has been successful in presenting a reliable healthcare alternative to the rural poor (in spite of problems with connectivity and electricity some times). People though consult the local practitioners for minor ailments; at times of medical emergency they use the MAP membership and consult the doctors at Christian Hospital.

• Improved access to hospitals through a round the clock ambulance service: Ambulance service significantly impacted the health seeking behaviour of people in the villages where call centres are established. This service is the only transport facility available at a phone call to the people in the target villages.

9

Tele-clinic in a district public health

Replicating Tele-clinic in district healthcare system – A model rural health service plan The Tele-clinic project could be replicated in the District Public Health System (DPHS) to improve the overall public health delivery system. Various public health hierarchies could be networked through the use of a telephone (or by joint venture with ISRO - Indian Space Research Organisation and DPHS). This would in a way improve the efficiency of various hierarchies and also would make them more accountable to both the public and to the DPHS. Moreover, such a network could make public health monitoring cost effective and efficient. The following needs to be done before actually replicating the system.

• Clustering different levels of healthcare centres – Lead centre at different levels.

• Identifying interested practitioners – Enlisted practitioners /specialists • Partnering with Telecommunications Department / Private Telecommunication Companies – Establishing communication network

10

• Establishing Tele-clinic information control units at all the district offices A model plan is depicted in the figure titled telemedicine in a district public health system.

Conclusions ICT - Not the complete answer – Need for location specific supplements ICT is not sufficient to ensure improvement in the well-being. Application of ICT should be supplemented with appropriate social protection policies which would enable the poor to actually benefit from information/knowledge. Practicing information is not just a function of availability of options but depends on the supplementary policies that enable practicing in real life situations.

Social orientation of private sector Not only the government, the private sector should also be socially responsible.

The IT companies and educational institutions should respond to the social cause through developing rural friendly communication kiosks and rendering technology education in rural areas.

Civil society - Capacity building of traditional actors Civil society institutions should take up the job of building the capacities of the traditional actors such as untrained health workers, private practitioners, traditional birth attendants and other health workers with in the community apart from their role of building partnerships. The Public Health Network through technology should include these actors who are working at the very local level. Linking them with qualified medical practitioners could bring change in overall health condition of the poor in rural areas. ICT could be also used in facilitating a continuing medical education to the practitioners in the rural localities. They are an important part of the ‘rural healthcare system’. However, the practices needs to be standardised through adequate trainings and regulation.

Call centres – Beyond healthcare The call centres could also perform as ‘knowledge banks’. This would be a twoway knowledge bank that gathers tacit knowledge from rural communities and promotes current information on various issues related to rural livelihood. The information on product markets, labour markets, commerce, etc. also could be made available through call centres, which could affect the livelihood of the poor living in the rural areas. The centre could be transformed as ‘knowledge centres’, which would have information on a range of human development aspects from health, education to livelihood.

The Mission 2007 of the government of India should be integrated into the Tele-clinic project and should focus on provision of information and knowledge beyond public health. There is no doubt that a careful promotion of information technology in rural healthcare could bring about drastic changes in the public healthcare system of India and this would benefit the poor who are excluded from the mainstream healthcare system. eHealth | November - December 2006

Cover Story

GIS AND TELEMEDICINE: TOOLS FOR PUBLIC HEALTHCARE

R

ecent IT innovations worldwide have been so impactful that they have been able to bring about paradigm shifts in almost all realms ranging from education, banking, governance to healthcare. Public health administrators across the globe today are putting in efforts to come up with a common agenda for using upcoming ICT applications to transform the domain of epidemiology.

One of the key objectives of e-Health is to enhance efficiency of current healthcare delivery system including,

sharing of information and engaging citizens for an advantageous arrangement, both between the government and the citizens. This is illustrated with the e-Health Matrix that comprises of stakeholders, e-Health tools, and ICT applications, all centered on the citizen.

The actors involved in the implementation of e-Health are healthcare organisations, physicians, policy makers, health management personnel, clinicians, paramedical personnel, pharmacists, application developers and citizens. These

Nidhi Dani GIS Engineer, RMSI Pvt Limited Noida, India nidhi.dani@rmsi.com

Sanjay P. Sood Head of School, C-DAC School of Advanced Computing Quatre Bornes, Mauritius sood@spsood.com

Prof. Nupur Prakash Dean, University School of IT, G.G.S.Indraprastha University, Delhi, India nupurprakash@rediffmail.com Prof. Victor Mbarika Professor of MIS Southern University and A & M College Baton Rouge, Louisiana, USA victor@mbarika.com

e-Health : Matrix of Stakeholders, tools, ICT and Citizen

November - December 2006 | www.eHealthonline.org

Rajeev Agrawal Kettering University Flint, Michigan, USA ragrawal@kettering.edu

11

actors use the WHO identified tools identified by the World Health Organisation (WHO) such as GIS, Telemedicine, Patient’s Information System, Decision Support System, Electronic Health Records, etc. to form the basis of their public healthcare setup. These e-Health tools further use existing ICT applications such as kiosks, Internet, email and video conferencing services as a backbone infrastructure to reach to the healthcare requiring public.

Why e-Health?

Of all the services that government engages itself in, public healthcare is the most sensitive domain as its quality and access has always been a major concern.

The main reason for such a concern is that in case of public healthcare delivery, if right information is not delivered to the right people at the right place and at the right time, many lives would be lost.

So far the Indian healthcare scenario presents a gloomy picture. Life expectancy hovers 4 years below the global average.

India is one such country where eradication of polio is still awaited despite the best efforts and numerous polio eradication drives. India ranks number one to home 5.7 million HIV AIDS patients, as per the UNAIDS Report on the global AIDS epidemic, 2006. Tuberculosis and malaria also take a high toll on health.

These grim statistics expose a yawning gap that needs to be plugged by Indian healthcare delivery system in India.

Ironically, on the other side, the next big Indian success story in the making is medical tourism. As per McKinsey & Company and Confederation of Indian Industries, healthcare tourism in India can rake over USD 2 billion annually by 2012.

But these strides cannot compensate for intransigent healthcare issues those are afflicting Indian public health.

Owing to the emergence of new global epidemics and unexpected spurt of natural disasters, these issues are attaining new levels of complexities. Counteracting to the complexities of epidemiological world, ICTs today are offering solutions that

12

enable access to knowledge warehouse in the least time possible and dynamic communication networks, surpassing national and international limits. Even more, efficient healthcare delivery to citizens has always been underpinned by various processes that enable exchange and sharing of information. Therefore, the following may be cited as some of the goals for e-Health tools to tackle healthcare: a) Identification of gaps between the healthcare delivery set ups and the vulnerable population with the help of information superhighways. b) Availability of information systems which nurture knowledge.

Linkages and or access pertaining to healthcare has already been enabled with the help of telemedicine technologies and the factors pertaining to availability of information systems with respect to public

potential to resolve some of the challenges affecting public health care. Geospatial Solutions comprising of GIS, remote sensing and spatial modeling; generally refer to a description of the characteristics and tools used in the organization and management of geographical data. Spatial data are commonly in the form of layers that may depict topography, healthcare statistics, healthcare demographics or environmental elements. Geospatial technologies have recently become an essential tool for combining various map and satellite information sources in models that simulate the interactions of complex natural systems.

Telemedicine on the other hand is defined as the use of communication networks to exchange healthcare information to enable clinical care and medical education.

Geospatial technologies for public healthcare

health (catering to various activities like reporting, surveillance, etc.) can be achieved with the implementation of geospatial technologies.

Geospatial, telemedicine and public health Geospatial, telemedicine and internet technologies form the components of public health informatics that have the

Geo-spatial technologies can be instrumental in more than one ways to help public healthcare activities throughout their life-cycle. As shown in the figure, GIS systems allow development of various health related maps, undertake spatial analysis on health data, create simulation models for various disease spreads and increasingly provide ‘up to date’event information right on the user’s mobile. eHealth | November - December 2006

Applications like disease surveillance systems, emergency planning systems and real-time response monitoring systems are transforming the way public healthcare systems used to operate traditionally.

Remote Sensing technologies, an aspect of GIS, can help model spread of diseases through satellite imagery by isolating areas that are more susceptible to the disease spread. Studies have also brought in a complete new paradigm linking meteorology – climate change studies –

capturing the information and providing appropriate health advice immediately.

Communication technologies form the enabling platform for both the systems to operate effectively.

Mentioned below are some of the key applications of GIS and telemedicine technologies in each of the five activities of public health: a. Event surveillance b. Event assessment c. Event verification

Public Health Activities and Informatics

GIS, remote sensing and disease spread monitoring.

On the other hand, with advancement in telecommunication mechanisms, the public health systems have become direct beneficiaries; owing to their large information exchange requirements. Telemedicine – a direct offshoot of this advancement in communication technologies, is emerging as very effective in the domain of public health.

In many ways, both these technologies complement each other. While GIS helps analysing health related events in a wider perspective, telemedicine helps in November - December 2006 | www.eHealthonline.org

d. Event information dissemination e. Event response

a) Event surveillance Epidemiological surveillance enables health care administrators to gather information that leads to the prevention or control or a better understanding of an outbreak, emerging infections and bioterrorism. The following information is extracted during the course of this activity: i) Where could be a possible event outbreak? ii) Is a particular health care set up equipped to handle a potential disaster?

iii)Which location is most vulnerable to a particular type of outbreak? iv)Do we have adequate resources (infrastructural and human) to tackle the outbreak? v) What is the risk attached with the spread of an epidemic? vi)Where should we have effective health campaigns?

If we notice carefully, a lot of relevant health related questions either point towards getting spatial intelligence or ask for core health domain information.

Conventional public health surveillance systems rely on manual operations and offline analysis and are smitten with limited effectiveness. Tabular information sometimes overlooks certain important dependencies and trends that are crucial to analyse and monitor an outbreak.

However, the mapping and analysing techniques based on geo-spatial technologies promise to enhance quality of epidemiological surveillance in terms of their (i) sensitivity, (ii) specificity, (iii) representativeness, (iv) timeliness, (v) simplicity, (vi) flexibility and (vii) acceptability. GIS uses map overlay techniques which view data pertaining to demographics, social infrastructure, healthcare institutions and patient’s geopositioned points - all in one view. This enables the user to have the ‘big picture’ of the outbreak scenario, while also having complete details of micro events.

One such surveillance system is Real-time Outbreak and Disease Surveillance (RODS) system, which incorporates GIS and telemedicine.

b) Event assessment Once an event is identified by a local health authority or people suffering from the ailment, event assessment is carried out by public health officials. It is done in order to plan out the epidemic or disease eradication strategy, calculation of the risk attached with the outbreak or visualising the impact that the event may have on the society. Assessment of a particular epidemic enables healthcare

13

administrators to get answers for the following queries: i) How would an event spread across geographies? ii) Which is the nearest hospital to cater to particular emergencies? iii)What could be the impact of the outbreak?

about confirmed and unconfirmed outbreaks of international public health importance. Active response action has to be taken if the danger and sensitivity of the outbreak is large, and corresponding to that adequate preparation is done.

Owing to introduction of ICT in public health domain, these days event verifi-

Linkages and or access pertaining to healthcare has already been enabled with the help of telemedicine technologies and the factors pertaining to availability of information systems with respect to public health can be achieved with the implementation of geospatial technologies... iv) On spreading further, who would be at high risk? v) How does the event outbreak affect the existing healthcare system?

GIS brings the capability to analyse data, using both the statistics and the spatial element, thereby giving a userfriendly output that defines the whole problem. Geo-statistical techniques like choropleth maps and spatial patterns produce results which allow the user to understand how the disease has travelled historically, across other geographies. The result is extrapolated with an extra usage of risk factors. One such geosta-tistical modeling technique, ‘kriging’, takes into account the existing underlying spatial structure of geo-referenced information (distances among samples or observations).

This technique is used for visualising the spatial pattern of the disease. Spread of the outbreak of severe acute respiratory syndrome (SARS) was analysed using GIS techniques.

cation converts large amounts of data into accurate information for suitable action and throws light on the following: i) Sensitivity/urgency of outbreak response ii) Population affected by the outbreak event iii)Planning for public alarm and resources WHO has established an innovative outbreak verification system that employs web-based telemedicine concept where the information is shared through emails for the needy.

d) Information dissemination The damages of a potentially dangerous outbreak can be minimised if the disease is subdued as early as possible. Therefore, for a timely and efficient response, the information about the disease and its extent must be reached and shared among healthcare institutions, medical bodies, NGOs and the government. The primary task of event information dissemination is to share the knowledge about the epidemic with the decision makers to help develop programs and policies for prevention and control activities.

Epidemic information dissemination activities answers queries like: i) Where has the event occurred or spread? ii) What is responsible for the event? iii)What is the status of current resources available at the disaster location? iv)Where are the experts located?

Geospatial intelligence, embedded in hospital information systems (HIS), provides a framework for managing, integrating, analysing, and communicating volumes of data. This enables hospitals to respond quickly to disease outbreaks.

Satellife [www.healthnet.org] is a pioneering project implemented in Ghana,

c) Event verification Event verification follows event assessment to display its potential importance based on the available background information, endemicity levels, and details of previous outbreaks. Verification mechanisms aim to improve epidemic disease control by informing key public health professionals

14

Public Health Informatics and its Architectural Components

eHealth | November - December 2006

Uganda, and Kenya in 2002. Satellife uses e-Health / telemedicine concepts for information, dissemination. Satellife is now working towards building a nationwide handheld computer network that will bring the power of email to health facilities in the periphery. It will also increase both their access to up-to-date information on HIV/AIDS, malaria, child and maternal health, and their ability to collect, analyse, and utilise data for decision making and resource allocation.

e) Event response Event response is the most crucial action for public health authorities because response at the wrong time, sent to the wrong person, with incomplete or untrue information can cost a number of lives.

Therefore, external expertise and help is required in order to mellow down the crisis.

Each response activity answers the following queries: i) Measuring accessibility to the deceased ii) Resource allocation as per geography (recorded history) iii) Visualising progress in damaged scenarios iv) Time stamping events in various locations v) Saturation capacity reports at hospitals vi) Options for utilisation of hospital space vii) Health information through the use of telemedicine viii)Assessing the aftermaths of the outbreak event Resource allocation is the primary step that any government takes in case of an outbreak. Therefore, allocation of teams with respect to their expertise, nearest areas to reach the needy, information on the existing social infrastructure such as roads, administration buildings, military camps, etc. are easily accomplished using geospatial technologies. Once the response teams reach the site of the event, mobile GIS gives an opportunity to record and send real-time data. Way back in November - December 2006 | www.eHealthonline.org

September 2001, Mobile GIS was used for recording the symptom information of the residents of Pennathur Village (India), to know the extent of damage being done by the dengue outbreak.

In case of emergency, hospital space management becomes a bottleneck in providing better response to the affected. Geospatial technologies not only help in the visual representation of hospitals down to the bed level, but also provide information such as hospital capacity, staff on call, number of patients enrolled, etc.

Analysis of the response action after the event has been curbed is important to the government officials for purposes such as auditing, planning for better future response, etc.

GIS – Telemedicine : The synergy As explained earlier, geospatial technologies used in combination with remote field data collection tools, connectivity to information highways, wireless application and satellite systems; hold a new promise for addressing infectious disease threats rapidly and effectively at local and global levels, even in countries with poor infrastructures.

Lot of time, energy and money is being spent on implementation of geospatial technology based applications in various municipalities and government departments. Telemedicine tools also are steadily seeping into healthcare delivery systems laterally at various levels and there are already some stories echoing success. Combining simultaneous implementation and use of these two eHealth tools can lead to cost optimisation, add more value, and highlight an integrated view of health information to the policy level user as well as to others in the field.

In summary the benefits of a ‘packaged’ GIS-Telemedicine solution for public healthcare include: • Better visualisation to public health experts.

• Remote sensing techniques (sub-group of geospatial technologies) help in the real-time monitoring of the epidemics/ outbreaks and facilitate in the formation of early warning systems.

Those could be reinforced with efficient telemedicine systems.

• Adequate guidelines about any emerging epidemic can be provided only if complete information of the geography, socio-economic and other data is available. Geospatial technologies can thus add another dimension to telemedicine by providing additional demographic information to the clinicians.

• On one side telemedicine links a medical consumer with the medical service supplier and on the other side geospatial technologies provide collective information on the epidemic and demographics. By utilising both these technologies, healthcare administrators can develop a realistic response and approach towards the epidemic.

Conclusion Owing high social relevance public health calls for special concern as far as e -Health is concerned. With rapid advances in technology today, investors in systems development need to step back and see how convergence in different technology streams could open up new possibilities.

Time is not far when technologies like distributed spatial data portals, geospatial libraries, etc. would transform traditional public healthcare into a form of ubiquitous healthcare. This transformation will come about with health grid and high bandwidth linkages, which those will enable delivery of vital information across the length and breadth of countries, and continents. Keeping in mind the exploding ICT scene, despite changing health needs, building and integrating comprehensive and responsive domain of public health informatics is very clearly a challenging but an attainable ideal.

15

Perspective

E-HEALTH AND THE HEALTHCARE SYSTEM

A

commonly accepted definition of e-Health is the application of Information and Communication Technologies to all of the activities of health care. The benefits derived from e-Health apply to both health systems at large, “public health,” and the individuals they serve. Shall we be proud of our accomplishments to date? What are the real issues?

What can a digital health system accomplish?

A fully digital health system can improve service at so many levels, that no list can be exhaustive. Some of the key benefits of e-Health include: • Individual medical error is reduced, whether for diagnosis or prescription thanks to increased coordination among healthcare professionals and realtime access by healthcare professionals to quality information resources • Greater medical coverage and followup are ensured, thanks to both telemedicine consultations and continuous monitoring devices • Toxic products can be more quickly withdrawn, since pharmacological side effects can be flagged through largescale use of electronical medical records • Epidemics can be spotted sooner

16

• Emergency transport is reduced, and appointments are better programmed • Primary prevention is facilitated, through the identification of at-risk profiles • Patient compliance can be improved through reminder services • Redundant services are reduced, freeing resources for other tasks • Costs can be better evaluated, because the information is available and policies adjusted accordingly • Last but not least: citizen-patients can be reassured by the quality of such a system, its integrated control mechanisms, and their own ability to access their full medical information from anywhere in the world

How far have e-Health systems progressed? e-Health is a work in progress. Many countries have named a national coordinator or taskforce, or at a minimum assigned the subject to the tasks of the national health ministry. But no national system provides all of the above services at the present time.

The Veterans Health Administration, an integrated health system serving American veterans, comes closer than most in taking advantage of e-Health.

VISTA (Veterans’ Health Information System and Technology Architecture) is an integrated clinical database and electronic medical records system that supports the daily management and delivery of health care services.

VISTA has the largest number of active electronic medical records in the world; approximately five million. Medication error in VA hospitals has been brought to

eHealth is a work in progress. Many countries have named a national coordinator or taskforce, or at a minimum assigned the subject to the tasks of the national health ministry. But no national system provides all of the e-Health services at the present time

Denise Silber Founder and Member Basil Strategies, France silber@basilstrategies.com

eHealth | November - December 2006

near zero. The medical reminder and alert system is active at all consultations.

The largest health maintenance organisation in the US, Kaiser Permanente, counting 8 million members, is also rolling out its ‘HealthConnect’ program that integrates the clinical record with appointments, registration and billing.

Both the Veterans Health System and Kaiser Permanente are recognized for their accomplishments in terms of quality of care made possible by the e-Health component of their system. The Veterans Health System has been especially cited for its respect of quality guidelines, which is significantly superior to other systems.

While these are both extremely impressive, the total population served by electronic medical records in the United States represents four percent of the 300 million Americans.

The Scandinavian countries have a long tradition of computerisation, electronic records, and telemedicine. But none of them offers all of these services to all citizens.

The National Health Service in the UK or NHS, has embarked on a 10-year programme aiming to make the UK fully “connected for health,” by linking all 30,000 professionals and 300 hospitals, creating an active EMR (Electronic Medical Report) for each citizen, implementing a booking service and electronic prescription. However, the programme ‘Connecting for Health’ has become a highly divisive, political issue.

Delays and public criticism are in the forefront of British media.

Why is e-Health not yet more advanced?

1. e-Health has been asked to satisfy changing objectives.

The definition of e-Health’s priorities has evolved, impacting the nature of the plans made to further e-Health’s development. New goals have been added on top of previous ones, making it increasingly difficult to satisfy expectations. The first objective to gain national and international attention was the elimination of medical error thanks to e-Health, as stated by Linda T. Kohn, Janet M. Corrigan, and Molla S. Donaldson, of the Committee on Quality of Health Care in America, Institute of Medicine. A report by the Institute of Medicine in 1999 estimated that tens of thousands of Americans died each year from errors that could have been avoided, given a more computerised health system.

This objective was followed by a second goal announced in various European countries and in the United States, of using e-Health to reduce the cost of healthcare by eliminating redundant prescriptions and consultations. A third objective is for e-Health to help make health systems more patient-centric. And a fourth is to use e-Health to eliminate fraud in health reimbursement systems.

2. Cost-benefit analyses of e-Health are inconclusive Cost-benefit analysis in healthcare is itself a recent discipline. So, for a strictly costoriented decision maker, it would be premature to make e-Health a priority without more research, although the clinical results are generally excellent.

When the Rand Institute simulated the potential savings of a health system (Hillestad et al, ‘Can electronic medical record systems transform health care?

Potential health benefits, savings, and costs’, Health Affairs, Sep-Oct 2005) wherein 90% of the population would benefit from an EMR, the results were quite different from what would be expected. The greatest gains were found in the reduction of hospital stays and in prevention programs, rather than in ordinary medical practice.

Motivated by the lack of cost-benefit data in Europe, the European Commission published a study in 2004 (www.cfst.dk/ dwn9144) regarding the cost benefit of electronic patient referral letters in Denmark. The authors sought to answer the question of whether it is cheaper to communicate a referral letter between private practices and a hospital, by post, fax, or email.

Why pick the seemingly small and unexciting subject of ‘transferral’ letters? By focusing on a very specific, low tech question, the authors were able to pro-vide solid data. And this study provided the opportunity to examine the econo-mics of the ill-understood relationship between hospital and in-city practice.

The precision of the analysis was remarkable. The conclusion was that an emailed referral generated a savings of USD 0.82 per year per Danish inhabitant, despite the required infrastructure. The result was based, to a large extent, on the 1,33 days gained by the electronic message. Extrapolated to a country of the

Benefit of Prevention programs made possible by e-Health Indicator

Flu Vaccine

Pneumonia Vaccine

Breast cancer

Cervical cancer screening

Colorectal Cancer screening

Target

+65

+65

+40 Female

F 18-64

+50

Frequency

1/yr

1/lifetime

0,5/year

0,33-1/year

0,1 - 0,2/year

Annual cost ; M = millions B = billions

$134-327m

$90m

$1-3 m

$152-456 m

$1,7-7,2 B

Gain /year

$32-72m

$500-1000m

$0-643m

$52-160m

$1,16-1,77B

Deaths avoided per year

5200-11700

15000-27000

2200-6600

533

17000-38000

November - December 2006 | www.eHealthonline.org

17

Country Australia

Population (Millions) 20

Canada

31

France

60

UK

60

Sweden USA Kaiser Permanente

8,9 300 8,4

size of France, the gain would be the equivalent of USD 51.04 million.

3. e-Health programs benefit little from knowledge transfer We have a long way to go before a costbenefit analysis, as thorough as the Danish example, can be applied to all of the steps of eHealth. Health systems are complex and generate too much information to analyse thoroughly, in terms of cost benefit.

Communication among IT specialists internationally has not led to a true transfer of knowledge and experience among the key programs. The variation in size of budget and cost per inhabitant in eHealth programs confirms that the programs are quite different in scope and definition; there are for example, ‘small budget’ and ‘large budget’ programmes, the former spending under USD 25.53 per person per year, the latter ten times as much.

How do these different countries define infrastructure? Can the electronic medical record be a fully operational file in the ‘small budget’ countries? Does a large budget lead to greater success?

4. Citizens are not pushing policymakers to support e-Health People who do not work in the field of eHealth have little or no reason to be informed about the subject. They are therefore not pushing policymakers to support e-Health, and many oppose eHealth on the grounds of insufficient protection of confidential data.

Professionals will also be allowed to

18

Programme • EMR • Infrastructure • Infrastructure • EMR EMR (DMP) NPFIT (national programme for IT) Health IT Infrastructure and EMR EMR

Budget m = millions B = billions 80 m • /7yrs 1,2 B • 700 m • 5,6 B • 300 à 600 m• 600 m•/yr 24 à 45 B•/10 yrs

4 • /7 yrs 60 • 22• 18 • 5 à 10 • 10 •/yr 400-750 • /10 yr

800 m •/yr 160 B •/10 yrs 2,4 B •

89 •/yr 540 •/10 yrs 286 •

withhold information that they consider it dangerous for the patient to see. While lawmakers felt that this was the price to pay for the creation of the electronic medical record, one can regret that the full potential of the EMR will not be attained.

5. The burden of the conversion to eHealth systems may appear unfair The introduction of e-Health practices changes the business of medicine, directly impacting the professionals working in the system. Integrated healthcare systems are better able than others to absorb that impact.

Why should one hospital or practitioner bear the cost of new tools, enabling them to link up to other hospitals and medical practices?

Why should professionals accept the fact that their records suddenly become available for inspection and comparison, unless they report to an employer who makes this mandatory?

If new software lengthens the duration of an appointment, how will healthcare professionals get through their workload, unless adjustments have been made elsewhere in the system?

We can see through these examples that integrated healthcare systems are at an advantage in adopting e-Health measures.

They can develop pilot operations and roll them out, benefit from economies of scale, and establish clear targets for the healthcare professionals and organisations they run.

Cost/Inhabitant

What are the components of an e-Health system?

A fully digital national e-Health system would include: • A wired infrastructure providing ubiquitous broadband access, • Computer workstations and mobile devices for professionals, available on site at consultations, operating rooms, emergency areas, ambulances and so forth • Intuitive software programs for electronic medical records, assisted diagnosis, and prescription • Telemedicine programmes linking patients to specialists • Phone triage systems for patients seeking assistance • Monitoring devices for the chronically ill • Professionals trained in the use of hard and software and motivated to use the above • Well-informed citizens who take an active role in their own healthmaintenance programs

How do we get there?

We have made remarkable progress in the past ten years, in terms of introducing the connected computer to healthcare. If we wish to truly take advantage of all that e-Health can offer, we need to transform healthcare itself into an integrated industry, where teamwork, process control, and evaluation are ordinary facts of life. eHealth | November - December 2006

Improved communication and information services are directly related to social and economic development of nations. Internet and modern communication platforms offer immense potential as multipurpose tools through which information and services can be delivered anytime and anywhere. However, upon delivery, the uptake of information and online services depends on the capacity of people and organisations. Again, of prime importance is service access points such as telecentres and borderless technologies like mobile technology as an way to address the 'reaching the unreached' and empowering the rural community. In the emerging global knowledge economy, it is imperative for countries, communities and enterprises to strategise towards adoption and use of Information and Communication Technologies (ICTs) and enhance their overall capacities. Asian countries are increasingly realising these critical factors of success and are becoming proactive in improving existing conditions.

A lot of collaborative efforts are required between governments, industry, academia and civil society across nations to materialise these objectives of balanced development in a digital era. eASiA 2007 is an open ICT for development cooperation platform for Asian countries for discussing opportunities and challenges for promoting growth of ICT for development in Asia through consultative dialoguing, strategic planning, knowledge networking and business partnering. eASiA, through its five seminal conferences, will focus on five emerging application domains of ICT for Development - e-Government, ICT in Education, ICT and Rural Development, ICTenabled Health services and Mobile application and services for development. The five conferences - namely egov Asia 2007, Digital Learning Asia 2007, Telecentre Forum 2007, eHealth 2007 and mServe 2007 will address the issues of digital divide and identify and explore opportunities for Digital Asia.

ASiA 2007

ASiA 2007 1

2

Asian nations are emerging as most promising global economies; traditional governments and their ways of governance surely need to be redefined. With a plethora of public management and administrative challenges facing most Asian nations, coupled with heightened expectations of rapid socioeconomic development, the need for efficient government is higher than ever before.

Modern ICTs provide boundless potential with proven credibility in transforming organisations and economies; governments across the world are increasingly getting active to embrace technology and leap-frog administrative reform.

With a purpose of creating an invaluable Asian platform for consultative dialoguing, strategic planning, knowledge networking and business partnering in the field of e-Government, egov Asia 2007 will bring together some of the best minds from the highest echelons of government, industry, academia and civil society to discuss and deliberate on the key strategies for e-Government.

Highlights: • National e-Government strategies • International and regional projects, case studies and best practices • Policy reforms for ICT-enabled governments • Models of e-Service delivery • Emerging technology solutions for eGovernment • Public private partnerships in eGovernment

ASiA 2007

ASiA 2007 3

Today Asian countries are competing with each other to be the frontrunner in technologyenabled education. While most countries do not want to miss the opportunity to connect to this ‘connected world’, the struggle to close the existing divides continues. Research and practices have confirmed that a holistic approach that integrates and emphasises process, be it capacity building of the educators or transforming pedagogy or creating localised and relevant ICT-based content, has substantial impact and sustainable and effective integration.

Asia has geared up to this challenge. Within these countries, while the private sector and the civil society has assumed leadership in some countries, governments in others are drawing the roadmap for a systematic integration of technologies in education.

Digital Learning Asia 2007 will bring some of the key drivers from the leading countries of technology-enabled education to deliberate on the pressing challenges of technology enabled education from capacity building to reengineering pedagogy, change management to providing digital access.

Highlights • National strategies on ICT in education • Localisation, customisation and content development • Educating the educators • Re-engineering pedagogy • e-Learning trend and practices in higher education and school education • Education technology trends in Asia

eASiA2007 EXHIBITION

Telecentres are increasingly emerging as one of the most important equalisers of digital divide among urban and rural citizens. Telecentres or common service centers are aimed at expanding access to ICTs. Telecentres as sustainable, multi-purpose service centres are emerging as a tool for empowerment of the community, enabling their access through ICTs to relevant information and common services.

The Asian Telecentre Forum 2007 aims to bring the Asian practitioners on a platform for learning and sharing the experiences. Experts will be engaged in close assessment of issues relating to project monitoring steered by external financial support, from international development agencies and governments in Asia.

Stakeholders from various sectors, viz., NGOs, Governments, Private sector, Donor agencies, Research organisations etc. will participate in this conference. There will be opportunity to showcase key project work and experiences through presentation sessions and/or panel discussions and through an exposition of products and projects.

4

There is a significant action happening in the sphere of e-Health globally led by experts in healthcare and hi-tech industries with an aim to fully harness the benefits available through convergence of the Internet and health care. eHealth is today’s tool for substantial productivity gains, while providing tomorrow’s instrument for restructured, citizen-centred health care.

The lack of adequate connectivity has been one of the biggest cause of the limited impact of ICT to bridge the digital divide. Mobile phones have spread throughout much of the developing world more quickly and deeply than any previous technology based as rolling out a mobile phone network is far cheaper than building a fixed-line systems and Internet networks for computers.

There are many examples of successful eHealth developments taking place in Asia including health information networks, electronic health records, telemedicine services, portable monitoring systems, and health portals. However, there are challenges to overcome in access, technology and the right practices. There are much more to gain from sharing knowledge on the existing practices and deliberating on the opportunities and possibilities that ICT use for healthcare delivery.

Mobiles offer a lot more services than phones and entertainment (Games, Screensaver, Ring tones, Movie clips). These include: news, stock prices; location tracking; telephone directory; mobile banking; ticket reservation; trading and so forth.

eHealth Asia 2007 aims to provide a platform to discuss the recent trends and emerging issues in the development of Information & communication science and technology and its integration in healthcare systems.

• Telecentre movement in Asia: Road ahead

Highlights

Highlights

• Partnerships for developing telecentre networks

•

e-Health in developing countries

•

e-Health administration and management

• Financing mechanism and sustainability factors of rural telecentres: A reality check

•

Rural telemedicine

•

Emerging technologies in e-Health

• Service delivery and capacity building through telecentres

•

Challenges and opportunities for collaborative action in e-Health

• • • • • • •

Highlights

For any information/enquiry contact: Himanshu Kalra himanshu@csdms.in Tel: +60166852201

PROGRAMME ADVISORY BOARD Chairman

Dato Dr. Halim Man Secretary General Ministry of Energy, Water & Communications Government of Malaysia

Convener

Dr. M P Narayanan President CSDMS India

Members

Dr. Milagros Rivera Associate Professor & Head Communications and New Media Program National University of Singapore

Maria Teresa M Camba Director, Field Operations National Computer Centre Commission on Information & Communications Technology

San Ng The Asia Foundation USA

Walter Fust Director General Swiss Agency for Development & Cooperation Switzerland

5

mServe Asia aims to discuss and showcase the different aspects of mobile services, technologies, implementation and implications, developments on the public administration and tie them to the existing and future m-Government, education, agriculture and other applications.The conference will provide a platform to share local and international developments, experiences and lessons learnt for knowledge sharing, and promote networking and business opportunity development.

Important Date Last date for receipt of abstracts: 25th November 2006

The eASiA 2007 conference will host an exhibition of latest e-solutions, services, initiatives and case studies from across Asia and beyond. Professional service providers, IT vendors, telecom venders, satellite providers, consulting firms, government agencies and national/ international development organisations involved in the domains of ICT for Development, education, governance and health, are participating in the exhibition.

ASiA 2007

Amitabha Pande Secretary Inter-State Council Ministry of Home Affairs Government of India

Devindra Ramnarine Adviser (Public Sector Informatics) Governance & Institutional Development Division Commonwealth Secretariat, UK

Nooraini Mohamed Ismail Dean, Faculty of Administrative Science & Policy Studies Universiti Teknologi MARA (UiTM), Malaysia

m-Government m-Learn m-Agriculture m4development m-Health m-Infrastructure m-Services

Conference Secretariat Centre for Science, Development and Media Studies (CSDMS), G-4, Sector - 39, Noida - 201301, India Tel. : +91-120-2502181- 87 Fax: +91-120-2500060 Web: www.csdms.in Email: info@csdms.in

Norma Mansor Dean/ Professor Faculty of Economics & Administration, University of Malaya, Malaysia

Dr. A T Ariyaratne Founder Sarvodaya Sri Lanka

R. Chandrashekhar Additional Secretary Ministry of Communications & Information Technology Government of India

International Government Partners The Commission in Information and Communications Technology is the primary policy, planning, coordinating, implementing, regulating, and administrative entity of the executive branch of Government that promotes, develops, and regulates integrated and strategic ICT systems and reliable and cost-efficient communication facilities and services. The Commission's aim is to develop the country as a world-class ICT services provider, provide government services to stakeholders online, provide affordable Internet access to all segments of the population, develop an ICT enabled workforce, and create an enabling legal and regulatory environment. www.cict.gov.ph

The National Computer Center (NCC) fundamental functions were to provide information bases for integrated planning and implementation of development programs and operational activities in the government. It was also tasked to provide computer service support, integrate electronic data processing (EDP) operations in government, and establish an EDP Educational Center.

Today, NCC lends its full support to the administration's ICT thrust by forging strategic alliances with the private sector, coordinating ICT activities, developing human capital, promoting ICT utilization in all sectors of the society, and advocating Philippine ICTs services worldwide. www.ncc.gov.ph

Supporting Partners The Asia Foundation is a non-profit, nongovernmental organization that supports programs in Asia that help improve governance and law, economic reform and development, women's empowerment, and international relations. The ICT Program of The Foundations encompasses eGovernance, ICT in Economic Growth and eCivil Society for fostering education and training through eLearning. www.asiafoundation.org/ Bellanet promotes and facilitates effective collaboration within the international community, especially through the use of ICTs. Bellanet aims to support effective development practice by sharing its expertise in information and communication technologies as well as its skills in facilitating organisational learning and knowledge sharing. www.bellanet.org The Commonwealth is an association of 53 independent states consulting and co-operating in the common interests of their peoples and in the promotion of international understanding and world peace.To help address disparities in education and improve its delivery the Secreatraiat directs its efforts at improving enrolment and retention in primary education and gender disparities at the primary and secondary education levels. www.thecommonwealth.org Swiss Agency for Development and Cooperation (SDC) is Switzerland's international cooperation agency within the Swiss Foreign Ministry. Together with other federal offices, the SDC is responsible for overall coordination of development activities and cooperation with Eastern Europe, as well as humanitarian aid. SDC's development cooperation activities in the Asian region aims at diminishing poverty, developing structures for a sustainable use of resources, supporting good governance, reducing social tensions, improving environmental conditions etc. www.sdc.admin.ch SEAMEO,The Southeast Asian Ministers of Education Organization (SEAMEO) was established on 30 November 1965 as a chartered international organization whose purpose is to promote cooperation in education, science and culture in

the Southeast Asian region. The vision is to have a dynamic, self reliant, strategic, policy-driven and internationally recognized regional organization for strengthening regional understanding and cooperation in education, science and culture for a better quality of life. www.seameo.org Sarvodaya is dedicated to making a positive difference to the lives of rural Sri Lankans. Sarvodaya are dedicated to the sustainable empowerment of people through self-help and collective support, to non-violence and peace. Sarvodaya's District Telecenters are the coordinating centers for all development activities of the organization in a particular district providing IT facilities for community development island-wide and coordinating between the Village Information Centers and each serves over 300 villages representing all the divisional secretariats within the district. www.sarvodaya.org telecentre.org is both a social investment program that supports grassroots telecentre networks and a loose family of organizations with a common commit-ment to helping the telecentre movement thrive. Telecentre.org aims to reinforce a global movement by finding ways that people, communities and networks can connect over common issues to make telecentres stronger and better, together. The telecentre.org strategy is to make investments to benefit the whole telecentre ecosystem. www.telecentre.org In India USAID is investing in economic growth, health, disaster management, environment and equity in India and in programs that focus on areas where help is needed most and people-level impact is high. USAID is also encouraging cutting edge alliances between U.S. and Indian organizations to quicken the pace of progress. USAID also promotes use of cutting-edge approaches in agriculture (biotechnology, improved production methods and marketing) and “e-governance� systems and promotes public-private partner- ships as the cornerstone of success of such initiatives. www.usaid.gov/in Warisan Global is a project management for knowledge initiatives and services outsource company based in Malaysia.

Set up in 2000, the comapny helps out government and corporate enterprises to deliver specific and specialised initiatives in ICT development and training programmes, aimed towards reducing the digital divide. www.warisanglobal.com

Institutional Partner

The National University of Singapore (NUS) is a multi-campus university of global standing, with distinctive strengths in education and research and an entrepreneurial dimension.The NUS mission comprises three mutually reinforcing thrusts: quality education, high impact research and service to country and society. NUS strives to provide a balanced, high quality education that nurtures the spirit of inquiry and initiative, and which allows students to realise their aspirations and potential. In recent years, NUS has carried out extensive researches in eGovernance and community development. www.nus.edu.sg

Perspective

MOVING BEYOND HOSPITALS: E-PRESCRIPTIONS Introduction In 1993, the American healthcare community was jolted by Institute of Medicine’s study which claimed that the mortality rate due to medical errors in United States is more than breast cancer, AIDS or motor vehicle accidents.

Subsequently, many studies were conducted to assess the impact of medical errors and majority of these concluded that preventable adverse events represent one of the leading causes of morbidity and mortality in patients. Today, as many as 100,000 lives are lost, with a cost of at least USD 2 billion every year for medical errors, as said by T.A. Brennan, et. al. in New England Journal of Medicine.

Although many approaches can be used to improve safety, IT has increasingly found a place in the healthcare delivery system as vital tool for reducing the frequency of medical errors. One of the most profound impacts has been due to the use of Computerized Physician Order Entry (CPOE) systems in outpatient and inpatient settings, and in particular, because of electronic prescribing.

Reducing medication error rates In a clinical scenario, a physician uses computers for three primary reasons – accessing and updating patients’ November - December 2006 | www.eHealthonline.org

electronic medical records, entering prescription information and communicating with other professionals involved in the patient care process.

Amongst all clinical computer applications, CPOE systems deliver perhaps the maximum benefit by increasing productivity, reducing costs and helping control medical error rates. The reason CPOE is so important is that most actions occur as the result of an order. In a study conducted in 1995, our research group found that there were about 20.7 ordering errors for every 1000 orders. Out of these, Adverse Drug Events (ADEs) occurred in 1% of orders and potential ADEs were found in 10% of orders. In one study, CPOE reduced the serious medication error rate by 55%, and in another study reduced the overall medication error rate by more than 80%. Thus, CPOE systems play an important role in controlling these errors.

CPOE systems facilitate the process of entering prescriptions into the computer.

They are usually linked to Electronic Patient Records and are developed with inbuilt Clinical Decision Support (CDS) algorithms. The CDS systems attempt to both suggest optimal choices, and also catch any errors in prescription orders that do occur. They alert the prescriber about allergies, contradications or noteworthy

e-Prescribing is the process of medication prescribing in an outpatient setting, using an ambulatory Computerised Physician Order Entry systems application linked with clinical decision support that can in addition electronically send prescriptions or prescriptionrelated information directly with the pharmacies or pharmacy benefit managers

Pushwaz Virk MBBS, MBA, MPH, from Harvard University Health Services, Cambridge, USA David W. Bates MD, MSc, from Division of General Medicine, Department of Medicine, Brigham and Women’s Hospital; and Partners HealthCare Information Systems, Clinical and Quality Analysis, and Harvard Medical School, Boston, MA, USA

23

issues. Even without CDS, CPOE standardises the prescriptions and ensures that the orders are legible and complete.

However, in a recent study on outpatient prescribing errors and the impact of computerised prescribing by it was shown that only the CPOE systems with advanced features like dose and frequency checks were able to prevent a high proportion of potential ADEs. In general, CPOE systems are slowly becoming more pervasive in hospitals, although penetration is only 5-15% currently. The rate seems likely to increase rapidly; in 2006, the Healthcare Information and Management Systems Society (HIMSS) published a study of Healthcare CIOs, listing CPOE systems as among the most important applications that they would like to implement by 2008.

Together, the CPOE and CDS systems greatly improve the safety, quality and cost effectiveness of providing medications to patients and can reduce medication costs both for the hospital and for society. In the inpatient setting, CPOE systems are directly linked to the hospital pharmacy systems. In the outpatient setting, however, CPOE systems are usually standalone without any network connectivity to pharmacies or pharmacy benefit managers. The CPOE system with decision support provides the physicians with access to patient’s medication history, drug information including drug-drug interactions, allergies, formulary information and

24

refill management. The physician can also track the previous medications the patient has taken or is concurrently taking.

Even though the use of CPOE systems has shown to decrease errors, many medication errors happen during the process of dispensing, transcribing or administration. Our hospital implemented a CPOE system in 1993 and on a subsequent evaluation, we found that the serious medication errors were reduced by half in inpatient setting but since majority of errors occur after the prescription ordering stage, a need was felt to link the CPOE systems to dispensing units in pharmacies.

e-Prescriptions - Definition and scope e-Prescribing is the process of medication prescribing in an outpatient setting, using an ambulatory CPOE systems application linked with clinical decision support that can in addition electronically send prescriptions or prescription-related information directly to the pharmacies or pharmacy benefit managers. Every year, more than 3 billion prescriptions are written in the United States. Any technological intervention that makes a small improvement in the medication prescribing process could thus lead to large benefits. By avoiding the cost associated with preventable illnesses, accurate and appropriate use of medications is the single most cost-effective technological solution

to improve patient care, according to J. Avorn, author of ‘The prescription as final common pathway’.

Over seventy five percent of office visits to internists are either due to continuation or initiation of medication. e-Prescribing has the potential to make this process much easier by seamlessly linking the various steps between prescription writing to dispensing - medication prescribing, data transmission, dispensing, administration and monitoring. Not only do manual prescription refill orders take up nursing and physician time, about 10% of handwritten prescriptions are not legible to the pharmacist. A lot of time is also wasted due to communication between pharmacies and physician practices for clarifications. Center of Information Technology Leadership (CITL) calculated that e-Prescribing systems could save over USD 2.7 billion annually by reducing clarifying phone calls. e-Prescribing can also lead to better tracking of patient’s compliance by physicians and insurance companies. The physicians can get updates when the patients get their prescriptions refilled. This helps to prevent non-compliance which is one of the major causes of ineffective treatment. Use of e-Prescription on a wider level could also be used as a valuable public health surveillance tool to monitor abnormal patterns in prescription dispensing in real time. This could be used to raise flags for example if there are increased prescribing rates for drugs used to treat upper respiratory infections.

Physicians could also potentially report any previously undocumented adverse drug events in the e-Prescription system which can be directly routed to the appropriate authority.

The Massachusetts Experience: eRx Gateway In the United States, every medication prescribed by a physician for a patient has to be in accordance with the patient’s insurance company requirements, which vary substantially from insurer to insurer with the result that no physician can eHealth | November - December 2006

remember the drugs that will be least expensive for an individual patient.

There are a variety of approaches for communicating prescriptions to pharmacies or chemists. These could be printed on a paper and physically carried by the patient, faxed or emailed where they are put together for dispensing. In Massachusetts, we have embarked on an initiative to link all physicians, pharmacies and pharmacy benefit managers to a central hub, which would route all prescription information. The hope is that this will become the primary gateway to route prescription transactions to retail and mail order pharmacies and would process requests for new prescriptions, modified prescriptions or cancel prescriptions, refill requests and eligibility checks.

In Massachusetts, the stakeholders have come together to create the foundation standards for e-Prescribing transactions, assess issues and design improvements through a community utility called Rx Gateway. The idea is to develop a standards based, open source, middleware messaging engine that connects physicians using e-Prescribing applications with the providers of e-Prescribing services i.e. eligibility checking, formulary enforcement, prescription routing and medication history retrieval. These include Pharmacies, Pharmacy Benefit Managers and Insurance companies. eRx gateway would serve as the foundation for connecting the entire state of Massachusetts and later offered for trial at other sites across US. Using this system, any physician in the state could securely, accurately and instantaneously transmit electronic prescription information to any pharmacy in the state.

Once successfully implemented, the software would be offered free of charge to any organisation that wishes to accelerate connectivity between existing prescribing applications and providers of e-Prescribing services. This middleware would eliminate the problem of interfacing any new e-Prescribing application with multiple existing ones.

As with any new implementation of a technology, some problems have arisen.

November - December 2006 | www.eHealthonline.org

For example, only about 60% of the state’s pharmacies are currently accepting electronic prescriptions. Even among the pharmacies that do receive them, there is variation regarding whether they capture them electronically in coded form, or print them out to be re-entered by the pharmacy.

Still, this effort represents one of the leading statewide efforts to implement ePrescribing in US. While implementation of e-Prescription can reduce the prescribing error rate, it had little impact on dispensing errors.

Dispensing errors can occur in two ways – one, when the pharmacist incorrectly reads the prescription, prepares an incorrect label and dispenses incorrect drug; the second is when the pharmacist reads the prescription accurately, prepares the correct label but dispenses incorrect medication.

In the second case, it might not be possible to ascertain the mistake unless the pills are called back and checked for error. The first kind of error is controllable if the pharmacist uses automatic label generator and has linked his/her internal systems to the e-Prescription system. The second type of error can only be completely prevented using robotic dispensing units but even there, there is always a chance of inaccurate filling of robotic dispenser.

ePrescribing: Global developments There cannot be a blanket CPOE system for different countries. Each system either has to be developed according to the country’s specific needs or customized according to the local processes and pharmacopeia information. Nonetheless, there are encouraging trends towards adaptation of e-Prescription technology.

Recently, the European Union adopted an “e-Health action plan” which mandated development of e-Prescriptions amongst the member countries. The estimates are that by 2010 e-Health spending could increase to 5% of the national health budgets; a growth of 500% in 10 years.

Similarly, OECD countries are starting initiatives to promote e-Prescriptions among member countries.

Sweden has been leading the world in healthcare IT adoption. According to Harris poll conducted in 2002, Sweden has EMR adoption rate of 90%, compared with about 17% in US. In April 2005, the European e-Government news reported that 45% of all prescriptions in Sweden were e-Prescriptions. The Swedish state owned pharmacy Apoteket has kept a target of 80% e-Prescription penetration by 2010. About one million e-Prescriptions are transmitted each month in Sweden.

The National Health Services (NHS) in the UK has also recently started Electronic Prescription Service at some pharmacies. Under Connecting for Health initiative, the NHS plans to provide ePrescription access to every GP surgery and community pharmacy by 2007.

Subsequently, they would integrate the ePrescribing systems with this service. The plan is to first extend the usage of e-Prescriptions to hospitals, ambulatory care centers, other pharmacies and the reimbursement authority over the next few years.

The European Union countries are also exploring possibility of cross-border ePrescribing. In a survey published in Aug 2006, lack of common standards between national systems and interoperability was cited to be the most important impediment to implementation of pan European e-Prescribing system. The eRx Gateway being implemented in Massachusetts could help in overcoming such obstacles.

Conclusion e-Prescription systems are at the ascending curve of the technology adoption cycle.

While it will be a while before these become widespread, progress can be expected to be rapid in a number of other countries.

Nonetheless, if the launch of the Massachusetts eRx Gateway is successful as expected, many other states can be expected to emulate it. Those countries with nationalised healthcare system will have an advantage in rollout of these systems because they can mandate a uniform standard across all of health care.

The potential benefits in terms of safety and efficiency are substantial.

25

Business News Now healthcare through mobiles Intel, in collaboration with Austin-Texas based Motion Computing, plans to launch a mobile technology platform to improve patient safety. The new technology will simplify work for the clinicians– doctors and nurses- who will be provided with slates called mobile clinical assistants for recording vital signs, medication and progress notes of their patients.

These will be available by the first half of 2007.

According to the vice president and general manager of Intel’s Digital Health Group, Louis Burns, the platform and slate are “designed specifically to address the unmet need of nurses and physicians working on the front line of patient care.” Motion Computing is working with Intel because it closely aligns with its tablet PC and healthcare industry expertise.

A unique feature of the prototype slate is an exterior casing that can be wiped clean with a disinfectant. “That is a must in preventing infections as the device travels with the clinician from room to room, and a big improvement from placing a device in a Ziplock bag to keep it infection free’, said Ray Askew, marketing manager for Intel’s health group. The slate has been designed strong enough to withstand a drop to the floor.

The mobile clinical assistants were pilot tested at El Camino Hospital in California. They will be further tested in other sites throughout the country.

A private healthcare network to be available soon eNotes Systems, Inc. announced to make available the world’s first Medical Information and Interactive Video Consultations between healthcare

26

professionals and patients. The network will allow for the safe transmission of critical medical data, as well as secure, real-time, interactive video consultations between healthcare professionals and doctors and patients.

is to improve patient outcomes and provide more personalised care and information, helping patients and doctors in turn, to make better assessment.

The firm’s intent is to put into operation a clinical decision intelligence system (CDIS) which uses the health system’s repository of clinical data derived from its decade-long use of electronic health record systems. It will also utilise open standard-based technology and other techniques that will lead to quick analysis and reporting of vital insights from millions of patient encounters.

eNotes has entered into a partnership with Jump Communications for this initiative. This joint enterprise will lead to the introduction of the first above technology to the telemedicine sector and is characterised by its proprietary hardware-based video compression algorithms; the simultaneous delivery and receipt of video at a constant 30 frames per second. Clients will be offered a private network to ensure secured transmission. Patients will be able to remain in the healthcare center, where they are comfortable. At the same time they will be able to obtain the expertise of an off-site medical expert without the need to travel. On the other hand, physicians will be able to examine patients online, they will also be able to store and forward consultations, procedures, and medical information for reference and learning.

Geisinger will also collaborate with the IBM Research Healthcare and Life Sciences Institute for identifying and implementing innovative healthcare projects and solutions.

Partnership to implement patientcentric health care model

Ken Lacey, global managing partner of Accenture’s Health & Life Sciences practice remarked, “As the industry moves into the digital age, healthcare organisations must streamline their approaches to information sharing by collaborating and organising around patient needs.” He also added, “By combining our strengths, SAP and Accenture will provide a key component to support the level of collaboration necessary to improve the accessibility, quality and affordability of healthcare.”

Geisinger Health System and IBM Corporation have collaborated to create a technology and data infrastructure to build the foundation for “21st century patientcentered care.” The aim of this venture

Collaborative health network on the anvil Accenture and SAP have entered into agreement to jointly develop a collaborative health network (CHN) solution. The network will help health-care organisations improve patient care. The CHN solution is designed to help the industry enhance quality of care, and control healthcare costs by providing an infrastructure to link a range of information which are accessible quickly by various users.

The solution will be available by the mid 2007.

eHealth | November - December 2006

Vice President, APOLLO HOSPITALS COLOMBO Deputy Director, Clinical Services, CHANGI GENERAL HOSPITAL Director of Planning & Healthcare Informatics, Centre for Healthcare Planning & Quality, DUBAI HEALTHCARE CITY Chief Executive Officer, GLOBAL CARE SOLUTIONS Sales Director, Healthcare Informations Solutions, ANZ-SEA, KODAK HEALTH GROUP Director, Healthcare & Social Clusters, INFOCOMM DEVELOPMENT AUTHORITY OF SINGAPORE (IDA) Director, Asia, Digital Health Group, INTEL ASIA TECHNOLOGY Vice President, MALAYSIAN HEALTH INFORMATICS ASSOCIATION Worldwide Executive Director Health and Human Services Industry, MICROSOFT CORPORATION Deputy Director (Health Informatics Standards), Health Informatics Center, MINISTRY OF HEALTH, MALAYSIA Chairman, Medical Board, NATIONAL UNIVERSITY HOSPITAL Head, Department of Cardiology & Clinical Research Centre, SARAWAK GENERAL HOSPITAL

Gold Sponsors

Head, General Surgery, SELAYANG HOSPITAL Group CEO, SINGAPORE HEALTH SERVICES, CEO, SINGAPORE GENERAL HOSPITAL Manager, Clinical Epidemiology & Health Outcomes, SINGHEALTH

Silver Sponsor

Endorsed by

Supported by

Media Partners

Online Media Partners

Organised by

Medical Informatics Specialist, SINGAPORE GENERAL HOSPITAL Director, E-Health Strategy, WORLD HEALTH ORGANISATION Scientific Coordinator, Surgical Research Unit OP 200 RobertRoessle-Clinic and MDC, Charite, UNIVERSITY MEDICINE BERLINE

HURRY! Register today!

For more information, please contact Ms Wati @ T. +65 6324 9750 E. wati@availcorp.com www.availcorp.com

Official Healthcare Media India

Case Study

E.HEALTH.NET: ICT AT GOVERNMENT HEALTH INSTITUTIONS

D

uring the past two decades, computers have revolutionised the way we live. The Information and Communication Technologies (ICT) are now part of every critical infrastructure, from telecommunication to banking to transportation. But usage of ICT and induction of e-Governance in health sector has remained very low as compared to other sectors, despite having a very high potential. The health sector, which is an important sector, should encourage ICT usage.

Keeping the above in mind, the NICHaryana State Centre and Directorate of Health Service, Haryana jointly initiated a mission mode project of e.Health.Net (ICT based health care system) during the beginning of the year 2003. The project mission was “To set up an efficient, effective, transparent and IT-enabled integrated system to provide the health care services to the people of Haryana so that their present position of health could be upgraded and uplifted”. Health Informatics is implemented to tone up the adminis-tration, facilitate accounting and enable effective management control. It also deals with collection, storage, retrieval, commu-nication and optimal use of health related data, information and knowledge base. Health Informatics was used in Haryana primarily with processing of data,

28

information and knowledge in all aspects of healthcare.

Identification of areas for e-Governance applications a. Public Centric Application includes Physical Disability Certification, Medical Certification, Birth and Death Certification, Blood Bank Computerisation (Net/web based), User Fee Collection & Utilisation Monito-ring.

The Hospital Computerisation includes Patient Registration, Admi-ssion, Discharge, Transfer, Bed Manage-ment, Wards Management Module, and Laboratory Information System and Telemedicine, for utilising superspecialty healthcare in rural blocks. b. Health Vital Statistics includes Medical certification of cause of death based on Form 4 and 4A, morbidity and mortality, Annual Administrative Report, disease prevalence - burden of disease based on ICD –X, performance indicators of health institution based on Form-D, monitoring implementation of Acts related to healthcare, Pre-Natal Diagnosis test-Prevention and control Act, Prevention of Food Adulteration Act, Employee Insurance Scheme drug procurement & distribution system, monitoring implementation of national and state health programme.

It is high time now, for extensive induction of eGovernance applications & ICT in health Institutions, which will result in better productivity, effectiveness, efficiency and economics leading to better health care to all. Haryana has understood the potential of ICT in health sector

Ghan Shyam Bansal Senior Technical Director & SIO, National Informatics Centre (NIC), Haryana India Dr. Ravinder Goel Deputy Director IT, Office of DG Health Haryana, India S.S.Duggal & Rahul Jain Scientists, NIC-HRSC, Haryana, India Anil Aggarwal In charge IT Cell, Office of DG Health, Haryana, India eHealth | November - December 2006

A Village Lab

c. Office Automation Packages includes personnel information system for medico staff, budget utilisation monitoring system, payroll system, medical reimbursement system, court cases MIS, centralised file movement and tracking, dairy/ dispatch. d. Decision Support Systems includes Medicine Inventory Monitoring and Control System, Doctors Leave / tours Monitoring Information System, Health Infrastructure Monitoring and Evaluation System, Survey module. e. IT awareness Activities like Basic IT training on office tools, exposure to latest happening in the field of health Informatics. f. Other National/State Level Programmes like School Health, Blindness Control, RNTCP / DOTS, Mother and Child Health, Family Welfare, Control of Vector Borne Disease. In addition there is a requirement of interface with other third party / external application software in Health Department

Strategy adopted in Haryana The e-Governance plan of the Health Department, amounting to Rs. 299.43 lacs November - December 2006 | www.eHealthonline.org

was approved by the ITPRISM (State level IT steering committee) in its 11th meeting held on 18 September 2003. The ICT infrastructure was created at State Head Quarter (HQ) and all districts at civil surgeon offices. To ensure the optimum utilization of ICT equipment, civil surgeons were advised to shift all the computers and computer manpower (irrespective of health programme/scheme under which computers and manpower were provided) to a common place. Internet/e-mail has been made functional in all the districts. All official communication has been put through cyber media (e-mail/Internet). Optimal uses of e-mail are being ensured.

Use of e-mail has been emphasized to save avoidable financial burden on the state exchequer.

District nodal officers have been designated who are responsible for overall implementation, supervision and monitoring and evaluation of the computerisation. They are coordinating with the civil surgeon, district programme officers and the state headquarter for smooth implementation of ICT initiatives in their respective district. To increase the computer literacy, an extensive training programme has been started at the State HQ. Training is ongoing as per training calendar. In house service orientation training of the employees of the districts are being carried out at the district headquarter. The district nodal officers and data entry operators are asked to coordinate the training activities and ensure its speedy completion so as to bring complete computer literacy in the district and send monthly report to State HQ through e-mail. Over the past two years, the NIC-HRSC has developed and implemented e-Governance solutions

for important key areas of health administration.

Application software packages developed and implemented Drug Inventory Monitoring and Control System Clinical Laboratory Management System Personnel Management & Information System Leave & Tour Monitoring System Health Infrastructure Monitoring & Evaluation System Budget Utilization & Management System Monitoring of Ambulances usage Burden of Disease based on ICD-10 Institute Performance Monitoring System based on Form –D Annual Administrative Report Generation System.

(URL http://haryanahealth.nic.in)Official Website of the department Hospital Registration and User Charges Module Implementation of Integrated Disease Surveillance Programme Medical Officer’s Counseling Software Recruitment Software for Medical Officer and Nurses

Application software development approach Low cost technology solution adopted in software development.

Tailor made modular approach adopted for software development under NICHrSC’s supervision.

Emphasis on taking modules keeping in mind monitoring aspect in first phase and few public centric applications like clinical lab computerisation, central registration and pharmacy store in health care institution Distributed processing emphasized and data updating through low cost e-mail solution.

All application softwares developed by NIC-HrSC Substantial amount spent on creation of facilities at HQ & field.

29

Bottom- Up approach adopted for software development & data collection.

Data collected is analysed, elevated and feed back is provided to all concern “Real Challenge is not the hardware or software but data collection from field & analysis and its utilisation for corrective decision. ”

Overview of e.Health.Net applications in Haryana Med-Centre of Haryana is an integrated software project for capturing utilisation of medicine inventory data and analysing consumption pattern of various medicine location wise to monitor disease occurrence pattern, pilferage and any other exception in the functioning of health institutions. Reports generated at various levels act as helping tools for multipurpose analysis and inferences, in order to provide affordable health care to common man by monitoring the flow of medicines.

Med-Centre capture the medicine data for 316 medicines under 23 various categories from 619 health institutions.

(54 general hospitals, 74 CHC, 401 PHC and 89 others health institutions) The software captures opening balance, receipt issued and closing balance of the medicine of pharmacy of the institute.

Presently data entry is done at Civil Surgeon Offices, which is transmitted to HQ every month (using e-mail). At HQ, data is consolidated and various statistical and analytical report are generated.

Doctor’s Tour/Leave MIS: In order to reduce the habitual absenteeism of doctors in rural areas, a system was developed wherein every doctor was to intimate his leave/tour/court case/ attendance, etc. in advance to civil surgeon concerned. This was entered in the system at district’s civil surgeon’s office and transmitted to HQ on a daily basis, which is then compared with the doctor wise reports, generated from field records randomly.

Burden of Death based International Code for Disease (ICD-10): This

30

system module is implemented in State Bureau of Health Intelligence (SBHI) and reports for the year 2003 has been generated using this software. This software has been developed for completion of MIS report for medical certificate for cause of death (form 4 & 4A). The system also helps in generation of ‘Cause of Death’ booklet automatically using data captured and elaborate analysis reports are also generated through software. The implementation of system has reduced the burden of manual compilation of this statistics, which used to take months, resulting in delay in publication of ‘Cause of Death’ booklet. Over the years, the implementation of system shall help analysis of data year wise and location wise through ICD-10 diseases classification and several other parameters.

Performance Monitoring of Health Institution: This system module is implemented in State Bureau of Health Intelligence (SBHI) and reports for year 2004 has been started generating using this software. Software has been developed to compile and process formD which has statistics pertaining to indoor and outdoor deaths at each health institution due to various diseases (based on ICD-10). Various analyses can be done which otherwise were a tedious job.

Doctor ’s Personnel Information System: The system has been developed to build database of all the doctors posted in Haryana. The system captures qualification, specialty, place of posting, and date of posting and other general parameters of the doctors like ACR/complaints/charge sheets if any.

The system is used for rational posting of doctors based on their qualification and availability of post at that location.

The system also generates gradation list of doctors. It helps the section in handling transfer/ACR and disciplinary cases in efficient functioning.

Disability Certificate Issuance System: This system has been developed to calculate and generate percentage of disability of physicaly handicapped candidate. The process captures various medical parameters based on medical examination of candidate and automatically calculate and generates certificate, using the guidelines and provision of Disability Act, Government of India. This has brought transparency in the medical examination and handicap certificate generation.

Website (http://haryanahealth. nic.in): The website gives insight of Health Department and also gives details of health schemes and programmes running in the state. The institute helps public in location of health institutions eHealth | November - December 2006

and facilities available in the state for primary, secondary and tertiary healthcare. Various policies and Acts related to health are available, along with downloadable forms. Geographical location of the health institutions is also available on the website. In order to bring transparency, charge rates of various tests are also made available on website.

Clinical Laboratory Information System: A phased approach has been adopted for the computerisation of hospital. In the first phase, lab reports were computerised. The reports give value of patient parameter along with normal range of tests for which report is generated. The system is implemented in all laboratories of general hospital.

The system also helps in generating MIS reports, for status of various tests conducted, which are generated at the

Presently the Health Institute (50 GH, 410 PHC and 2345 Sub-Center) has been mapped. This shall be linked with parameter data (health indicators), which will be used for planning & monitoring.

Budget Monitoring System: This system captures expenditure and receipt under various heads, from all the locations of health department. The reports generated help in monitoring expenditure increase under various heads against allocation under that head. This helps in proper utilisation and monitoring of funds available with department. It also helps in reconciliation process with the treasury.

Monitoring of National Health Programmes: Software has been developed for compilation of progress reports, receipt from field location at head office and generated under

The implementation of e.Health.Net has also resulted in capturing of error free data at source and its availability at state headquarter for planning better health care system for masses... end of day, monthly and yearly basis.

These are helpful for doctors and civil surgeons for inference purpose.

Medical Bills ReimbursementProcessing System: This system is developed to automate the processing of medical reimbursement claims for indoor/outdoor treatment of Government employees and their dependents.

The system captures charges claimed for medicine, room rent, consultation, injection and processes the same by using preferred admissible changes for the same. This helps in reduction in processing time of bills and also ensures transparency and uniformity in the process. The system has been given for implementation in all the departments of Government of Haryana.

GIS Mapping of Health Institutes: Introduction of GIS for monitoring various schemes and programme of health using GIS has been initiated.

November - December 2006 | www.eHealthonline.org

various National Health Programmes.

The programme for which module has been developed are:- School Health Care Programme, Family Welfare, Mother and Child Programme and monitoring under Prevention of Food Adulteration Act. The analysis report is monitored by health administration.

Results achieved/anticipated The implementation of Medicine Inventory Monitoring and Control System and Doctors’ Attendance Monitoring System has reduced the absenteeism, resulting in increase in availability of doctors. The implementation of the system has helped in monitoring distribution, availability and consumption details of medicines supplied for public in all health institution of Haryana. Software captures the medicine data for 332 medicines under 23 different categories from 618 health institutions (54 general hospitals, 74 CHCs, 410 PHCs and

89 others health institutions) in all the 20 districts of Haryana. The system helps in efficiently managing inventory function, distribution of medicine from central store, using parameters like minimum buffer stock (reorder level), OPD inflow, population covered and consumption pattern. The medicine consumption data helps in monitoring the efficiency of the functions of OPD. Exception figures in reports are used to check the malfunction like pilferage or non-functioning of OPD in a particular institution. Implementation of the system in all the districts of Haryana has resulted in checking the pilferage of medicines, increase in availability of medicine at government health institutions, increase in attendance of patients/doctors in health institutions and optimal utilisation of medicine.

The implementation of Disability Certificate Issuance system has brought transparency in the medical examination and handicap certificate generation.

Clinical Laboratory Information System has helped in generating MIS reports, for status of various tests conducted, which are generated at the end of day, monthly and yearly basis. These are helpful for doctors and civil surgeons for inference purpose. Various charge rates of different tests have been made available on the health website. There has been a significant reduction in patient waiting time.

The implementation of e.Health.Net has also resulted in capturing of error free data at source and its availability at State Headquarter for planning better health care system for masses. The e.Health.Net system works on low-end ICT resources and e-mail based data transfer from district HQ to state HQ.

Transferability/replication The e.Health.Net is a generic eGovernance solution for health sector, which can be replicated in any state / Union Territory (UT) health department.

The NIC Centers are functioning in each state and district, therefore the transferability of the solution is easy across all States and UTs in India.

31

View Point

FUTURE OF E-HEALTH IN INDIA IS BRIGHT “The biggest advantage, which has been in favour of e-Health in our country is that now, the Ministry of Health has started taking an active part. The Ministry of Health has taken the initiative of setting up a task force for telemedicine, which is an advisory body”, says Dr. Shashi Gogia, President, Indian Association for Medical Informatics, or IAMI, engaged in promoting application of informatics in the fields of healthcare, bioscience and medicine in India, in an interview with Sanjeev Shrivastav of eHealth What is your vision of e-Health and how do you foresee the future prospects of Medical Informatics in India and beyond?

The concept of e-Health is that each and every citizen’s data is available at the time of need, and that data is utilised at the time of epidemics or disasters such as Tsunami so that needy patients or victims can be identified with their case history.

So making a National Population Database is essential. A person, where ever he or she is staying, can be facilitated a good quality health care through this process of eHealth. These are the basic things which telemedicine and utilisation of Medical Informatics in India can provide. The November - December 2006 | www.eHealthonline.org

future of e-Health in India is bright. It can help in the progress of healthcare in our country.

Keeping the patient’s history is very important for the success of e-Health programmes in totality. The very base of telemedicine depends on keeping the basic patient record. When the doctor knows what the basic problem is, he or she can give a much more focused attention to the problem of patient. The diagnosis will be accurate. Till now what is being done in telemedicine is sending the x-ray across to the doctor but on that basis, accurate analysis cannot be done. So what is required is the availability of text data to the doctor. Diagnosis will be easier and

accurate if it is done on the basis of the text of the patient’s basic health record.

So each and every doctor should have an EMR (Electronic Medical Records) system for recording patients’ health records.

Why is it important for a country to adopt the system of e-Health? Has it become a necessary requirement of our times? e-Health is definitely a necessary requirement especially in a large country like India as we are in such diverse locations. People, for instance, in the hilly areas have to travel long distances to bring the patient to the doctor. With the introduction of e-Health, at least 50% to

33

60% of this travel can be cut down. But eHealth is much more than that. There has to be National Population Database, and availability of this data online as well as its effective utilisation.

Please let us know briefly about the project you did during Tsunami disaster in Tamilnadu, India.

We did a project for an organisation called SATHI (Society for Administration of Telemedicine and Healthcare Informatics), which is into promoting the concept of medical informatics. The devastating Tsunami occurred at the end of 2004. The very first effort of telemedicine that happened from our side was psychiatric consultation at the Tsunami affected areas where we arrived for the rehabilitation phase of disaster management. With the help and association of OXFAM, SCARF (Schizophrenia Research Foundation) and other non-governmental organisations, we could provide psychiatric treatment using the various tools available for Medical Informatics.

The key to e-Health is to connecting the patient using Information and Communication Technologies. Are patients at present prepared enough in developing countries, especially in rural areas, to adopt this?

While doing our first project we connected together the cities of Bhopal and Itarsi (in Central India) with telephone network, and we found that patients are very eager to use this. In fact the medical community

is less so. And for the patients where there is no health care available anything is better than nothing. How ever, the only way to make telemedicine a success, is to incorporate the travel cost as genuine health care cost.

As networking and interactivity are the main attributes of e-Health and well structured network is a must have phenomenon for the success of any eHealth programme, what should and can be done to enhance the system of interactivity and networking?

This is very interesting. The biggest advantage, which has been in favour of eHealth in our country is that now, the Ministry of Health has started taking an active part. The Ministry of Health has taken the initiative of setting up a task force for telemedicine, which is an advisory body. I happen to be a very key member of that task force. One of the first things they are doing to facilitate this networking to take place is to develop the standards. The main reason for standardising is that there are so many vendors in the market having different standards, resulting in escalating costs. We are trying from our side to make it cheaper so that telemedicine becomes a day-to-day reality.

Please elaborate on the various eHealth initiatives, which has been taken by your organisation in association with Oxfam India Trust.

The main project was the Tsunami project about which I have mentioned earlier.

Since now we have the domain experience, what we are really branching out to is the National e-Governance initiative in which 100,000 Common Service Centres are going to be started.

There we have been approached by a lot of organisations because they do not have the experience of telemedicine.

Telemedicine has to be a key element for these kiosks. If this initiative is restricted to government only, then it is not going to work. The common masses, to whom the government wants to reach, cannot afford high costs. The government has to work with the local providers who are affordable. This is what we are trying to focus.

As President of IMAI, please let us know briefly about your future initiatives?

IMAI started in 1993 to basically provide the computerisation of medical facilities. But over the years, as the concept of telemedicine and e-Health came up, we are now expanding our activities for the entire gamut of IT and medical care. So far we have been a small association but fortunately this year we have taken a big leap in terms of membership. We are the official member of International Medical Informatics Association. Our main goal is that each and every medical facility should use IT because we feel that it will help in bringing in efficiency and will also provide quality health care services.

Narayana Hrudalaya: Creating excellence in telemedicine network Narayana Hrudalaya Telemedicine Network (NHTN) is one of the largest telemedicine networks in the world, running through 26 locations in India and overseas. Established at the same time as the Narayana Hrudalaya (Bangalore, India), NHTN aims to provide cardiac care to the rural population. The Network offers video consultation round-the-clock, primarily for heart patients from remote areas. Through the ECG Network, using ordinary telephone lines, a large number of ‘family physicians’ are networked with NH for early diagnosis of heart attacks. The network has been instrumental in treating over 12,000 patients in the last two years, entirely free of cost, proving to be a boon for a developing country like India.

Sponsored by the Indian Space Research Organisation (ISRO), the basic infrastructure of telemedicine is provided in remote locations whereby the remote centres can interact directly, using audio and video support with the specialist using digital communication link. The software to transmit data is provided to the remote centres to transmit the basic data of the patient to the specialist location before the schedule of tele-consultations.

For details: http://www.hrudayalaya.com/

34

eHealth | November - December 2006

World News EU awards Health e-Health records gets eLife as project of the a push by the US month government The European Union awarded project of the month status to the Health-eLife project, which aims to promote the deployment of network-based services across Europe.

The project supported by the EU eTen initiative, uses doc@HOME technology, from UK-based telehealth services firm Docobo, that enables health providers to manage patients with terminal diseases in their own homes, initially for heart disease, respiratory disease and diabetes. The system provides patient information in a format compliant to HL7 messaging standards and is therefore compatible with current developments in Electronic Patient Record and existing primary and secondary care healthcare computing systems.The system works by staff keeping track of their patient’s progress and sending them messages when they need to communicate with their patients.

In this project, two of the products of Docobo, viz., the HealthHUB handheld patient monitoring device, and the webbased doc@HOME system are being used. The two products are designed to work together in helping clinicians and nurses monitor the health status of their patients, without having to hospitalise these patients, since with these devices authorised general practitioners, clinicians and nurses can access their patient information at any time and from any location, using their secure access codes.

EU eTen spokesperson said, “The focus of Health-eLife is the exploration of implementation requirements for the deployment of the new doc@HOME Tele-Health service and the preparation of a business plan to attract investors and formalise deployment.”

November - December 2006 | www.eHealthonline.org

Sate governments in the United States are promoting the use of electronic health records in order to give a boost to the use of information technology in the field of medicine so that doctors statewide can have access to patient records. Already, these governments have started organising task forces of hospitals, doctors, insurers and other groups to develop plans for such regional systems.

Federal government’s call in 2004 to develop electronic patient records throughout the United States has led to many state governments taking up eHealth records initiative. 38 states are now participating in statewide or community discussions, while 21 of them are leading the coordination of efforts.

However, most of such endeavours are in the initial stage, with only plans for a technology system being ready. The implementation of these plans will take time, money and effort. “The dollars continue to be the major limiting factor,” said Dr. Kenneth W. Kizer, chairman and chief executive of the Medsphere Systems Corporation, a California health information technology company that sells electronic health records using an open-source platform, known as OpenVista. Many of the nation’s hospitals do not even have the money to bring the systems to their own institutions, he said. At the same time, health experts and officials say that allowing hospitals to choose their own programme would

present a major challenge in creating a seamless statewide system. If a state is to capture economic benefits of electronic health records — including reductions in medical errors and duplication of tests — doctors treating patients will need access to patients’ records no matter where the patient approaches.

Common IT system for patient records in Singapore A programme to help general practitioners manage patient health records and related information through a common IT system was launched by the Singapore government.This common IT system, also known as the integrated clinic management system, is envisaged as a four years programme with an investment of around USD 9.4 million.

Infocomm Development Authority of Singapore (IDA), the country’s infocomm regulator, reported this.

Yong Ying-I, Permanent Secretary at Ministry of Health, said, “Using IT can bring important new benefits to patients—real-time access to timely and accurate patient information will help doctors provide better care to patients.”

The system became operational from 1st of October, making it possible for general practitioner’s (GP) from 1,400 clinics in the country to update and retrieve their patients’ health records through this new system. The integrated clinic management system will be developed

by Singapore-based companies CrimsonLogic and Frontline Technologies.

Previously, medical practitioners and small GP groups worked on different systems to process different processes.

IDA’s chief executive Chan Yeng Kit, pointed that, “With more than 80 percent of the primary healthcare sector managed by GPs, the integrated clinic management system will form a fundamental building block of an infocomm-enabled personalised healthcare delivery system.”

35

Eliza, a friendly robot to attend sick children Telemedicine researchers of University of Queensland in Australia are using a robot by the name of Eliza to bridge the distances and to improve the delivery of specialist medical care.

Developed by university’s Centre for Online Health - a world leader in telemedicine research - Eliza, has already began its work at Mt. Isa Hospital this week. The wireless robots can be wheeled to the bedside of sick children for video-link consultations with Brisbane specialists, reducing the need for local doctors or families to travel to the city for specialist care. A built-in camera and microphone enables the specialist to see and speak with the child.

Adebola, President of the Society remarked that, “e-Health is an option for Nigeria in order to remedy the human resource for health crisis, failing health systems and facilities, inaccessibility and non-affordability of existing services to the poor and vulnerable in the rural areas.”

Digital imaging fast replacing X-rays in England The digital way of diagnosing fractures is gaining acceptance and replacing the previous system of film-based X-rays in England. More than half of the health clinics have switched over to this digital system, called the Picture Archiving and Communications Systems (PACS) that can send images of broken bones and fractured ribs instantly to different clinics.

The robot project is an extension of the telepaediatric research led by the Centre for Online Health, in collaboration with the Royal Children’s Hospital in Brisbane.

Nigeria government coming up with national e-Health policy The Nigerian government will soon have a national e-Health policy, to be able to fulfill the goal of using ICT in area of not only education and food security but also for health care of its citizens. This was stated by the President Olusegun Obasanjo at the State House with an eight-member delegation of the Society for Telemedicine and e-Health in Nigeria.

At the same time, President Obasanjo urged the members of the Society to give more attention to e-Health infrastructure and training of personnel so as to ensure the successful implementation of the policy.

Lauding President’s reformative measures for the healthcare system, Dr. Olajide

36

Project to promote eHealth among nurses A Nurse Prescribing Project is being implemented in Devon and Greater Manchester in UK to investigate how IT could be used ‘to support prescribing by nurses and improve patient safety, clinical governance and every day communication’. The project will inform the development of national nurse prescribing standards.

This is a six-month-long project, and a part of the National Health Services (NHS) Connecting for Health’s Nursing Development Programme. The project will look at how current processes can be developed to support prescribing practice from a professional standards and information technology viewpoint.

The project began at East Devon Primary Care Trust and Bolton Primary Care Trust on 1st September and will initially consider how nurses currently prescribe and how technology could improve this in future.

Doctors yet to fully accept e-Records

The National Health Service (NHS) plans to invest 1.86 billion USD through 2014 in the PACS project. Although the PACS project is criticised for being expensive and having procurement problems, it has proved to be a successful NHS initiative to modernise its IT system.

PACS eliminates film and developing costs, the NHS said. Images are viewed on a computer screen, also eliminating lightboxes and microfiche readers, the NHS said. The system has also reduced the number of lost X-rays, since they are securely stored on the network.

Citizens too are finding PACS as very beneficial as it does away with the treatment delays while images were physically sent to specialists.

Maintaining electronic records for patients is yet to be fully adopted by doctors, according to a study by David Blumenthal, from the Institute for Health Policy at Massachusetts General Hospital in Boston.The study found that less than 1 in 10 doctors use electronic records in the most effective way.

The study was conducted in wake of President Bush setting a goal for most Americans to be covered by electronic health records by 2014. The Robert Wood Johnson Foundation funded the research.

The e-Health records entail collecting patient information, displaying test results, helping doctors make treatment decisions and allowing health-care providers to document prescriptions and medical orders electronically.Advocates, including the pharmaceutical and technology industries, argue that eHealth | November - December 2006

standardised electronic records that can be shared among care providers would improve patient care, reduce errors as also curb unnecessary tests and paperwork. But the concept is controversial among many privacy advocates, who fear that sensitive personal information could be accidentally compromised or exploited by hackers, companies or the government.

The study revealed that about only one in four doctors use some form of electronic health records. On the contrary, it was also found that an increasing number of doctors are adopting electronic record systems every year. Another important finding is that doctors practicing alone or with one other doctor were much less likely to use the e-Health records. “That is significant because half of all doctors in the United States practice in such settings”, said Ashish Jha, an assistant professor at the Harvard School of Public Health, who led the study.

In view of the fact that till date, there has been little hard data on electronicrecord use and why and where the technology has been slow to catch on, Blumenthal study is a ‘seminal report’ that could serve as an important annual benchmark, said Karen M. Bell, Director of the Office of Health IT Adoption in the Department of Health and Human Services.

Citizen participation in e-Health urged The participation of citizens is a must in national discourse on e-Health policy to meet out the goal of promoting ICT in healthcare. The European Health Telematics Association (EHTEL), a key group of European informatics professionals, pointed this out.

“Currently, most discussions about the development of e-Health systems happens between the developers and national institutions where there is very little interaction between those November - December 2006 | www.eHealthonline.org

organisations and the patient,” according to the report on home care by the EHTEL, presented at the World of Health IT conference in Geneva, recently.

Also, the organisations empanelled to advise health ministries on issues of personal health and national healthcare priorities look beyond only patients with chronic illnesses instead of being inclusive.

EHTEL seeks the establishment of an independent, pan-European corporation going beyond international differences in reimbursement and pricing mechanisms, semantic standards, branding and compo-sition of medicines, and language.

Baroness Emma Nicholson of Winterbourne, representing Southeast England, called for personalised health monitoring and care a “development of great potential.” “Improving ICT infrastructure must become a top priority, and policies must reflect this,” Baroness Nicholson said, adding that policy-makers ought to link the health, and general ICT and telecommunications sectors within their own countries.

The system envisioned by the study would give doctors and pharmacists access to information about a patient’s prescriptions — who’s prescribed the medication, what dosage it’s for, whether they’re on any other medication, and what pharmacies have filled the prescription. The most apparent benefit of the system is that it reduces the risk of error in filling prescriptions that sometimes occurs when a pharmacist tries to read a doctor’s handwriting, researchers say.

“The feeling is that it’s easier to track when it’s all electronic,” said Darla Wise, one of the two Concord researchers who compiled the study, released in September. “With a system like this, you can track if medication has been prescribed by multiple doctors or if it’s been filled by multiple pharmacies, whether they’re in the same chain or not,” she concurred.

Pakistan Minister invites Japanese companies The State Minister for Information Technology of Pakistan, Ishaq Khakwani invited the Japanese companies to invest in their telemedicine and telecommunication sector. Both these sectors have tremendous scope for growth, according to Khakwani, who said this to a six members delegation of the Marubeni Corporation of Japan.

e-Prescriptions to minimise misuse of medical prescription The electronic prescription not only saves time and money, but can reduce abuse of prescription medication, a study

by Concord University (US) reports.

The study recommends that West Virginia should take steps to have an ‘ePrescriptions’ pilot programme for 350 to 500 doctors in place at the earliest.

The initiative will lead to savings of around 184 million USD, as per the study.

The groundwork for the sector has already begun with the government utilising all its available resources to ensure penetration of broadband services across the country and efforts are on to introduce telemedicine in areas with inadequate health services.

37

Project Showcase

@HEALTH - PROJECT FOR INTERNATIONAL COOPERATION Scenario The @HEALTH project contributes to the development of international cooperation in the e-Health sector between European and Latin American organisations, facilitating the identification of organisations and competences, and the sharing of best practices and knowledge; creating a nurturing environment for technology transfer actions.

Objectives of the project The objectives of the @HEALTH project are: • To promote scientific cooperation in the field of e-Health applications and technologies, through web-based and off-line matchmaking actions.

• To set up a proactive network where researchers from different countries, cultural and technical backgrounds, exchange skills, thoughts, needs and knowledge on e-Health.

• To link health sector players with ICT research organisations and industries, stimulating technology transfer actions tailored towards end users needs.

• To stimulate and sustain technology transfer actions and joint RTD projects, supported by public and/or private funding programmes.

• To act as an open forum to foster dialogue between e-Health users, technology developers and researchers from different European and Latin American countries.

• To provide an exhaustive database of relevant organisations in Europe and Latin America and their expertise in the field of e-Health.

38

• To facilitate sharing of best practices and needs in eHealth, and to support exchanges of researchers between Latin American and European organisations.

Project description The project intends to pave the way for international scientific cooperation in IST through the following services and actions: • The development of the eHealth Virtual Community platform, a web portal where players can share knowledge, encourage cooperation and drive R&D and economic growth in e-Health sector.

• A comprehensive database of European and Latin American organisations operating in the e- Health sector, accessible through the @HEALTH web platform.

• The organisation of annual brokerage events, where relevant players can meet to share knowledge and thoughts, and to explore possible collaboration.

In 2006 and 2007, the events will be held in Caracas and Madrid, respectively.

• Information services to the @HEALTH community, including making news on relevant RTD projects and funding opportunities for RTD actions and technology transfers available.

• Direct support to technology transfer actions, including partner search, eligibility check for funding proposals and identification of funding instruments.

Expected results & impacts The main impact of the @HEALTH project will be the realisation of specific technology transfer actions between Europe and Latin America in the field of e-Health technologies and applications.

The @HEALTH community favours the dissemination and application of existing e-Health solutions, tailored to suit the local needs and standards, as well as specific research actions that will lead to the development of scalable, flexible and usable technologies. This will in turn lead to longterm benefits for the research sector in e-Health and consequently for the medical sector, as well as for citizens themselves.

@H E A LT H (Project cofunded by the European Community under the “Information Society Technology” Programme) Website: http://www.ithealth.org http://ciaotech.it Duration: May 2005- April 2007 eHealth | November - December 2006

Have your daily cup of hot morning tea with hot e-Government news!

Log on to www.egovonline.net

6-8 February, 2007 Palace of the Golden Horses Kuala Lumpur, Malaysia

The LARGEST e-Health Conference & Exhibition in ASIA Join and get involved!

www.csdms.in/eHealth