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HEALTH CARE
health care
What is the definition of Health? How is the health of a nation measured, what are its key indicators? What role does the government/individual play in providing good health to its citizens?
image 04: Word bubble- understanding health care
The health care delivery system consists of a large number and a variety of institutions— dispensaries, primary health care institutions, small hospitals providing specialist services, large hospitals providing tertiary care, medical colleges, paramedic training schools, laboratories, etc.
Health and health care need to be distinguished
from each other for no better reason than that the former is often incorrectly seen as a direct function of the latter.
Heath is clearly not just the mere absence of disease. Good Health confers on a person or groups ; freedom from illness - and the ability to realize one’s potential. Health is therefore best understood as the indispensable basis for defining a person’s sense of well being.
The health of population is a distinct key issue in public policy discourse in every mature society often determining the deployment of huge society. They include its cultural understanding of ill health and well-being, extent of socioeconomic disparities, reach of health services and quality and costs of care & current biomedical understanding about health and illness. Health care covers not merely medical care but also all aspects pro preventive care too. Nor can it be limited to care rendered by or financed out of public expenditure- within the government sector alone but must include incentives and disincentives for self care and care paid for by private citizens to get over ill health. Where, as in India, private out-of-pocket expenditure dominates the cost financing health care, the effects are bound to be regressive. Heath care at its essential core is widely recognized to be a public good. It cannot be established on considerations of utility maximizing conduct alone. Despite the size and reach of the public health care system, however, India scores poorly on most generally accepted health indicators . This may, in part, explain the growing role of the private sector in addressing India’s health care needs.
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HEALTH CARE
Fig 09: 36
A visual analysis of Public policies and its impact from 1947-2015 has been shown.
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HEALTH CARE
HOW & WHY DID WE REACH THIS SITUATION ? The evolution of India’s health system can be categorized into three distinct phases: Phase I (1947-83)-when the health policy was based on two principles: t That none should be denied care for want of ability to pay, and t That it was the state’s responsibility to provide health care to the people. From fig 09, it can be seen that govt’s policies were aimed at planning to eradicate epidemics diseases such as Malaria, small pox, plague & Cholera. The govt also focused at family planning. However, people faced an extremely high maternal mortality rate, poor sanitation standards, lack of basic facilities such as - access to water, nutrition & education. Phase II (1983-2000)-when the first National Health Policy of 1983 articulated the need to encourage private initiative in health care service delivery, while at the same time expanding access to publicly funded comprehensive primary health care. From the fig 09, it can be seen that huge subsidies were given to the private sector, whereas utilization of public facilities decreased by 19 %. Access to free health care also decreased from 19% to 10%. The shortcomings of this phase weret No regulations, standardizations for monitoring private sector. t Absence of surveys for measuring risk factors, designing interventions, launching campaigns. t Decentralization programs not implemented t No R & D centres to promote innovation in health care t No investment in skill development & human resources.
Phase III (post-2000)-which is witnessing a further shift that has the potential to profoundly affect the health sector in three important ways: t The desire to utilize private sector resources for addressing public health goals; t Liberalization of the insurance sector to provide new avenues for health financing; and t Redefining the role of the state from being only a provider to a financier of health services as well. The overview of the plans and policy reports not only throws light on the gap between the rhetoric and reality but also the framework within which the policies have been formulated. There has been an excessive preoccupation with single-purpose driven programmes. Above all, the spirit of primary health care has been reduced to just primary level care. The health reports and plans mostly concentrated on building the health services infrastructure and even this lacked a sense of integration. Most of the policy reports miss out on the importance of a strong referral system. Instead, there has been more emphasis on building the primary level care and even that has lacked proper implementation. The Bhore committee report and later, the Primary Health Care Declaration discussed the operational aspects of integrating the other sectors of development related to health. The multi-sectoral approach that is much needed and the inter-sectoral linkages that are essential for a vibrant health system have not been well thought out, and there has been no plan drawn out for it later.
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HEALTH CARE
types of sector & facilities Health care Sector can be divided into three different facilities-
PUBLIC FACILITIES t t t
Primary Care (in rural areas): 22,271 primary health care centres and 137,271 sub-centres. Secondary Care (health care centres in smaller towns and cities): 1,200 PSU (public sector units) hospitals, 4,400 district hospitals, and 2,935 community health care centres. Tertiary Care (specialized hospitals): 117 medical colleges and hospitals.
FACTS: figure 10: Health expenditure distribution between public & private sector
OVERVIEW: The Indian health care delivery market is estimated at US$ 18.7 billion and employs over 4 million people, making it one of the largest service sectors in the economy today. Public health expenditure accounts for less than 1 % of GDP compared to 3 % of GDP for developing countries and 5 % for high income countries. The private health care sector in India accounts for over 75 % of total health care expenditure in the country and is one of the largest in the world.
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1. Low capacity of Rural public infrastructure. 2. Lack of good management & with adequate funding plague the existing public hospitals at district and sub-district levels 3. There is a need for better routines more accountable staff and attention to promote quality. 4. Many reputed public hospitals have suffered from lack of autonomy inadequate budgets for non-wage O&M leading to faltering and poorly motivated care. 5. No system exists for purposeful community focused public information or seasonal alerts or advisories or community health information to be circulated among doctors in both private practice and in public sector. 6. PHCs were meant to be local epidemiological information centers which could develop simple community.
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HEALTH CARE
THE RISE OF THE PRIVATE SECTOR The responsibilities of private sector in clinical and preventive public health services were not specified under the NHP 1983 nor during the last decade of reforms followed up either by government of profession by any strategy to engage allocate, monitor and regulate such private provision nor assess the costs and benefits or subsidization of private hospitals.
PRIVATE FACILITIES
PUBLIC- PRIVATE PARTNERSHIP ( PPP )
The private health care providers consist of private practitioners, for profit hospitals and nursing homes, and charitable hospitals. They are numerous and fragmented. In the absence of a national regulatory body, some private providers practice without minimum standards and the quality of treatment varies from one provider to another. The average size of private hospitals/nursing homes is 22 beds, which is low compared to other countries.
Public-private partnerships have also emerged as one viable method of growing the health care sector while keeping public goals in mind. The main objectives of public-private partnerships are to improve quality, accessibility, availability, acceptability, and efficiency of health care services.
Size of hospitals 84 % of private hospitals 10 % 5% 1%
<30 beds 30 â&#x20AC;&#x201C;100 beds 100-200 beds >200 beds
Compared to a few private institutions primarily in the form of charitable trusts and small nursing homes, recently a number of large sized Indian companies have ventured into health care delivery.
The focus is on reorganization and restructuring of the existing health infrastructure at primary, secondary and tertiary levels to reduce inequities and regional imbalances in the health sector. This includes delegation of powers to local bodies. The National Rural Health Mission calls for a holistic approach to health development, supported by relevant human resource capacities, convergence, integration, and public-private partnerships. The scheme provides an opportunity for promoting equity, serving the under privileged, and empowering communities in a sustainable manner.
Companies like Max India, Ranbaxy Laboratories, Escorts, Wockhardt and Birla have established Specialty Hospitals. There is increased interest is diagnostic service as well, with companies such as SRLRanbaxy, Nicholas Piramal, and Dr. Lalâ&#x20AC;&#x2122;s laboratory venturing into this field. Emergence of corporate hospitals has led to increased professionalism in medical practices and use of hospital management tools.
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HEALTH CARE
rural + urban perspective RURAL PERSPECTIVE
URBAN PERSPECTIVE
India is a country of wide disparity. Be it religion, culture, languages, food or health care. According to a report on Health care in India, Emerging market report 2007 by PriceWaterCooper; Healthcare is one of India’s largest sectors, in terms of revenue and employment, and the sector is expanding rapidly. The total value of the sector is more than $34 billion (1.88 Trillion INR). This translates to $34 per capita, or roughly 6% of GDP. By 2012, India’s health care sector is projected to grow to nearly $40 billion . The private sector accounts for more than 80% of total health care spending in India.
In the urban areas, there is more focus on secondary & tertiary health care services, aided by high end technology which provide specialized western approach to health care. Over the last several decades, independent private medical practice has become widespread but has remained stubbornly urban with polyclinics, nursing homes and hospitals proliferating often through doctor entrepreneurs. The tertiary hospitals in major cities are in many cases run as profit making businesses rather than providing effective health care. These hospitals use hi-tech specialization creating demand from the critically vulnerable at increasing costs. Standards in some of them are truly world class and some doctors who work there are outstanding leaders in their areas But given the commodification of medical care as part of a business plan it has not been possible to regulate the quality, accountability and fairness in care through criteria for accreditation, transparency in fees, medical audit, accountable record keeping, credible grievance procedures etc. Such accreditation, standard setting and licenser systems are best done under self regulation, but self regulation systems in India medical practice have been deficient in many respects creating problem in credibility.
However, when it comes to availability of health care, there are two India’s: a. The country that provides high-quality medical care to middle-class Indians & medical tourists, b. And the India in which the majority of the population lives—a country whose residents have limited or no access to quality care. According to 42nd ( 1986- 87 ), 52nd ( 1995- 96 ), and 60th ( 2004 Jan- Jun) rounds of National Sample Survey Organization ( NSSO ), the % of ailing persons who got their ailments treated is found to be higher in the urban areas than in rural areas. This clearly shows that health facilities in urban area are more advanced that the rural areas.
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Acute care has become the key priority and continues to attract manpower and investment into related specialty education and facilities for technological improvement. Common treatments, inexpensive diagnostic procedures and home remedies/medicines are being replaced and priced out of the reach for most citizens in urban areas.
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HEALTH CARE
understanding PHC Primary care is the term for the health services by providers who act as the principal point of consultation for patients within a health care system.
CURRENT STATUS OF PHC > INDIA
image 05: Dr. OmPrakash oversees a patient at a PHC in Pune.
The first point of contact when a patient falls sick, to
get primary consultation as to identify the cause of a problem is termed as Primary Health Care. Such a professional can be a primary care physician, such as a general practitioner or family physician, or depending on the locality, health system organization, and patientâ&#x20AC;&#x2122;s discretion, they may see a pharmacist, a physician assistant, a nurse practitioner, a nurse, a clinical officer or an Ayurvedic or other traditional medicine professional. Depending on the nature of the health condition, patients may then be referred for secondary or tertiary care.
Primary Health Check up centres in many parts of the country face many problems. These are: 1. Poor Goal Setting & lack of formulation of strategic Interventions t Lack of access of hospital care ( physical ) t Lack of integral system of health care ( no coordination between primary- secondary - tertiary bodies t Shortage of funds t Adequacy of infrastructure & access to alternative sources of care t Profit making attitude in private - primary sector t Quacks/ fake doctors/ alternative solution t Approach to Curative care than preventive care
Geographical Barriers Miscommunication Financial Support Lack of Infrastructure Ethical Malpractices Policy Issues
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HEALTH CARE
2.
Management Failures
Management failure due to a combination of reasons Financial Support such as low budgets, untimely and irregular supplies, corrupt practices and poor governance has adversely affected the functioning of the Corruption health system. The dispersed and disaggregate nature of responsibilities, and conflicting job profiles make accountability a difficult proposition. Lack of performance based system for health care work- Poor Management ers is another factor that leads to poor management. Under various programmes and in some States, such performance- based monitoring is done but is neither timely nor systematic Absenteeism from place of workA majority of doctors opt for specialization and/or urban practice. The reluctance to serve in rural areas has become a major impediment in the government’s ability to provide health services to the rural population Poor payment systems and dual practice to compensate for the relatively low salaries, doctors are permitted private practice outside office hours or are given a non-practising allowance, often 25% of the basic pay. Lack of monitoring, effective supervision and, at times, collusive relationships are causes for the abuse of this facility affecting patient care in public facilities. 3. 42
Limited role of the State
ANALYSIS This analysis clearly highlights the dire need of effective health care service model that can assist people in providing them with timely & correct guidance. In this case, most of the users will belong to rural area & belong to lower middle class. These are people who cannot afford expensive health care expenditure & have no assurance. However, it is also observed that after dowry, maximum loans are taken to pay for medical facilities. If a medical service that can reach across the diverse geographical terrain of India, much like the penetration of mobile phones, & is available for the masses 24 * 7, even as guidance or of re-assurance value that a patient’s problem has been addressed to, it may have a great value in today’s scenario.
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TECHNOLOGY
technology in health care
Over the last decade, the need to develop & organize new ways of providing efficient health-care services has been accompanied by the major advances in information & communication technology ( ICT ). This has resulted in a dramatic increase in the use of effective ICT applications in health care, collectively known as e-Health.
Primary health care is thus the main target of the eHCD ( Health care delivery ) program.
image 06: image of various ICT products & services in Health care
Government of India in its effort to increase accessibility to health care facilities is taking important initiatives of standardization of exchange of health information between different entities within the health care sector. The Ministry of Health & Family Welfare and the Ministry of Communication and Information Technology are jointly creating a national health information infrastructure, for easy capture and dissemination of health information.
According to report published by WHO,
TELE-MEDICINE FACTS There are more than 150 tele-medicine initiatives today most of it are supported by Indian Space Research Organization and IT Ministry.
E-health is the use , in the health sector, of digital data-transmitted, stored & retrieved electronically- in support of health care, both at the local site and at a distance. Through these applications, it is possible to take specialized care to primary health-care centres in remote areas and thereby broaden and improve the quality of the services they offer. By connecting primary health care workers to primary health care centres & connecting these centres electronically to departments and referral centres in hospitals for the exchange of data a significant improvement in access and cost-effectiveness may be affected.
In principle, tele-medicine has bridged the urban rural divide by taking health care to interiors of India.
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TECHNOLOGY
CURRENT SCENARIO Majority of the hospitals in the country are rooted in manual processes, which are unable to cope with the volume of data generated. In the larger hospitals, patient records remain difficult to access and these adversely affect quality of health delivery. The demands of the insurance sector for more efficient information storage and retrieval are also going to add to the pressure on hospitals and health providers. This may, in fact be the major driving force for modernization of this sector since the health insurance sector is poised for major growth in the coming decade. The current Government health policy is also shifting its emphasis towards health insurance. Automation is the only solution that will can help hospitals to meet the challenges of modern health care delivery.
DEVELOPMENT OF E-HEALTH INITIATIVES IN INDIA The major demand for updated solution started with the establishment of the large corporate hospitals many of which like the Apollo group, implemented strong IT solutions in the latter half of the nineties. With the increasing demands of the market, many sturdy, standard HIS ( Hospital Information System )solutions were developed by the major IT companies. Today, the Health care segment is, in fact, going through the kind of evolution that the banking and financial services sector went through a decade ago. This is being driven by the huge annual increase in the number of hospital beds mostly in the corporate sector. 46
However, the government still owns 66% of the Indian hospital market. The Central Government has also announced setting up of large new hospitals. The public sector hospitals have realized the direction in which the wind is blowing. This can be appreciated by the fact that Delhi Government has recently approved HIS solutions for four of its major hospitals. In the current scenario, 75% of the qualified consulting doctors practice in urban, 23% in semi-urban (towns) and only 2% in rural areas where as the vast majority of population live in the rural areas. Hospital beds/1000 people are 0.10 in rural as compared to 2.2 in urban areas. Further, a vast proportion of north and northeastern region of country lie in hilly terrain and some territory in remote islands making health care reach impossible to such far flung areas. Tele- health care concept is no longer new to the country. Both government and private agencies are venturing into it. Few Indian companies are being capable of providing hardware and software solution for tele- health care. Efforts are directed towards setting up standards and IT enabled health care infrastructure in the country.
HEALTH INFORMATION SYSTEM PROVIDERS The major players in this field, are CDAC, Wipro, TCS and Siemens Information Systems Ltd (SISL).
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TECHNOLOGY
telemedicine Tele medicine is the use of telecommunication and information technologies in order to provide clinical health care at a distance. It helps eliminate distance barriers and can improve access to medical services that would often not be consistently available in distant rural communities. It is also used to save lives in critical care and emergency situations.
image 07: Tele-medicine van by Apollo Group of Hospital
APOLLO TELE MEDICINE NETWORKING FOUNDATION ( ATNF )
COST TO PATIENT A cost benefit analysis has shown that economic benefits to the patients have been far more than the investment made in this project.
Apollo is a pioneer in the field of Tele-medicine in India and is credited with being the first to set up a Rural Tele-medicine Centre in the village of Aragonda in the state of Andhra Pradesh. ATNF works with multiple entities including the medical bodies, private and public sectors, Central and State Governments both at a domestic and international level to popularize the concept of Telemedicine. ATNF offers customized solutions addressing telemedicine support for primary, secondary and tertiary level of health care. Simulations of Tele-consultations between Apollo Hospitals, Hyderabad, Chennai and Dubai for cases specific to Cardiology, Neurosurgery & Orthopedics were also done.
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TECHNOLOGY
image 08: treatment of patient by tele-medicine
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image 09: Implementation model of telemedicine by SGPGIMS
DIT + ISRO
SGPGIMS, Lucknow
Department of Information Technology(DIT), Indian Space Research Organization (ISRO) of Department of Space, and other public and private organizations have started Telemedicine projects in different parts of the country.
Sanjay Gandhi Postgraduate Institute of Medical Sciences ( SGPGIMS), Lucknow is a tertiary care referral hospital has been actively involved in telemedicine since 1999. It is connected with three medical colleges of Orissa ie Cuttack, Berhampur and Burla through VSAT(very small aperture terminal (VSAT), is a two-way satellite ground station). It follows the systemic approach through proper scheduling of telemedicine sessions well in advance. Different departments conduct regular tele-education, tele-consultation and tele-follow up sessions by exchanging patientâ&#x20AC;&#x2122;s, history, xâ&#x20AC;&#x2122;rays, pathology slides etc thus the patients are given the specialist consultation regarding the treatment, follow-up after the treatment at SGPGIMS.
Tele-medicine for diagnosis & Monitoring of tropical diseases in West Bengal using low speed WAN, developed by Webel (Kolkata), IIT, Kharagpur and School of Tropical Medicine, Kolkata has been implemented. The system has been installed in School of Tropical Medicine Kolkata and two district hospitals. Project on setting up of telemedicine facilities at two referral hospitals and four district hospitals using West Bengal State Wide Area Network of 2 Mbps is also under implementation. Telemedicine network utilizes Internet connectivity in addition to leased lines. The project was implemented by C-DAC, Trivandrum and RCC. More than 4000 patient consultations have been done till date using the network.
SGPGI is now setting up a School of Telemedicine & Biomedical Informatics in its campus with the objective of meeting the demand of highly skilled health technologist in this emerging area.
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TECHNOLOGY
electronic health record The Electronic Health Record (EHR) is a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. ADVANTAGES OF EMR (source: www.eproberesearch.com )
FUTURE SCOPE Many of the medical, dental, nursing, pharmacology and other health care degrees do not have courses on information technology. The industry has grown to such a size that people from Non-health care backgrounds are being recruited and trained. Interestingly, a lot of youngsters with traditional health care degrees such as MBBS and BDS are exploring career options in e health
image 10: Image of EHR application from https://drchrono.com/
The Electronic Health Record (EHR) is a longitudinal
electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data, and radiology reports. The EHR automates and streamlines the clinicianâ&#x20AC;&#x2122;s workflow. An EHR is generated and maintained within an institution, such as a hospital, integrated delivery network, clinic, or physician office. An EHR is not a longitudinal record of all care provided to the patient in all venues over time.
With help of EMR, Doctors are able to treat the patients better with easy and accurate data accessibility. The collection of clinical data at the point of care enhances the efficiency and improves the data quality. The pharmaceutical companies and regulatory authorities use the collected data to improve the post marketing surveillance PMS of drugs. The patients receive better and greater reimbursements. In summary, EMR reduces revenue leaks, increases patient satisfaction and increases the efficiency of the process through technology. Although EMR has tangible positive outcomes, the adoption rate in India has been low. The market comprises handful of hospitals using EMR. The usage of EMR is limited to corporate hospitals in the various metro cities of India. The known hospital chain Fortis and Apollo have been using EMR in a few of their hospitals. In comparison to developed nations, the adoption of EMR in India has drastically low. The low adoption rate is due to several gaps existing from the doctors to EMR vendors.
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TECHNOLOGY
ENTRY BARRIERS t
t
t
t
t
t
The lack of awareness about the benefits of EMR is the largest perceived barrier. The prevailing low awareness about the advantages of EMR among the small and medium scale health care service providers is limiting the adoption rate. Due to lack of compatible technology available in the market, doctors are resistant in adopting new technologies. Additionally, the EMR necessitates the use of computers by the doctors. Along with doctors, the stakeholders operating within a hospital are defiant in changing to the EMR. The high cost of implementation increases capital requirement. This is beyond in reach of the small medium scale hospitals. The capital intensive EMR will add to the health care service providersâ&#x20AC;&#x2122; financial burdens. The fragmented Indian health care market that does not have a steady revenue and cash flow might view that capital burden as a risk. The implementation process of time that negatively influences the ongoing workflow in any hospital. The vendors implement the various modules of EMR in phases. This implementation process affects the ongoing workflow in the hospital. Lack of user-friendly interface adoption. The complicated EMR interfaces discourage the technological defiant doctors in adoption. Additionally, the EMR are inadequate to capture the entire data gathered by the doctors. The vendors lack domicile knowledge in health care. This results in development of EMR with various gaps. Technology being the primary competence of the vendors, they tend to develop products that highly are incompetent. The gap existing between the information technology and health care needs to be bridged by vendors to develop effective EMR products.
Some of the major EMR providers in India include: t t t t t t t t t t t
GE Healthcare VEPRO Siemens Softlink International Prognosys Srishti Software CDAC Televital Akhil Systems Pvt. Ltd. Tata Consultancy Services iSOft
Some of the hospitals in India using EMR are: (2009 Data, eHealthonline)
t t t t t t t t t t t t t
Amrita Institute of Medical Sciences, Coimbatore Apollo Hospital, Chennai Artemis Health sciences, Gurgaon Christian Medical College, Vellore Fortis Hospital, Mohali and Delhi Manipal Hospital, Bangalore Max Devki Devi Hospital, Delhi P D Hinduja Hospital, Mumbai Ruby Hall Clinic, Pune Sahyadari Hospital, Pune Sri Sathya Institute Of Higher Medical Sciences, Puttaparthi Sri Sathya Institute Of Higher Medical Sciences, Bangalore PGIMER, Chandigarh
Note: Most of the hospitals in India are using GE Healthcare 50
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TECHNOLOGY
health information system DOCTORâ&#x20AC;&#x2122;S PERSPECTIVE ON EMR According to an independent research it has been observed that majority of the physicians are familiar with EMR functions & benefits & only 20 % said that they are unfamiliar with EMR. It has also been observed that area of practise has a moderately good association with familiarity of doctors with EMR. It has been further observed that Allopathic & dental doctors are more familiar with EMR function and benefits as compared to homeopathic, therapist & other practitioners.
Another observation made is that highest ranking was given to the function of EMR that deals with the various types of entries & displays(diagnosis, medication, clinical notes, lab results etc) Whereas structured documentation & display of demographics was ranked lower. However writing of prescription was given the least ranking. This may be so because of familiarity of physician to use paper, as well as use of abbreviations for writing prescriptions.
image 11: Various functions of Health Information System.
t
It helps as a decision support system for the hospital authorities for developing comprehensive health care policies.
t
Efficient and accurate administration of finance, diet of patient, engineering, and distribution of medical aid. It helps to view a broad picture of hospital growth
t
Improved monitoring of drug usage, and study of effectiveness. This leads to the reduction of adverse drug interactions while promoting more appropriate pharmaceutical utilization.
t
Enhances information integrity, reduces transcription errors, and reduces duplication of information entries.
HIS are comprehensive, integrated information systems designed to manage the medical, administrative, financial and legal aspects of a hospital and its service processing ADVANTAGES t
Easy Access to Patient Data to generate varied records, including classification based on demographic, gender, age, and so on. It is especially beneficial at ambulatory (out-patient) point, hence enhancing continuity of care. As well as, Internet-based access improves the ability to remotely access such data. 51
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TECHNOLOGY
Technology has really impacted banking, e-commerce , transportation industry, but health care sector has always been risky to deal in. Thus, it is important to do research on business models that have â&#x20AC;&#x153;clickedâ&#x20AC;? as well as those that fell flat! Though research on advancements in the health care technology suggests significant developments on the perception of health care. Sometimes bringing a radically new , well - intended health care technology to help people track their health, may fall flat if not timed well .
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TECHNOLOGY
google health In the year of 2008, Google launched two new services in the market. Both the services were user-centric & enabled them to take better control of two important sectors of their lives, yet both the services failed. These services were: Google Health + Google Power meter. But could not find a way to translate that limited usage into widespread adoption in the daily health routines of millions of people. Hence the project was withdrawn from the market & termed as a failure. TECH- SPEAK
The goal of Google Health was to create a service that would give
people access to their personal health and wellness information. Google wanted to translate their consumer-centred approach from other domains to health care and have a real impact on the day-to-day health experiences of millions of our users. However, within a few years of experience, they observed that Google Health was not having the broad impact that they hoped it would. There had been adoption among certain groups of users like tech-savvy patients and their caregivers, and more recently fitness and wellness enthusiasts.
Brian Dolan, Editor of Mobile Health News suggests that the problem with Google Health was that it did not offer incentive to use it, it positioned itself as a data repository and not much else. Another tech analyst John Moore said that â&#x20AC;&#x153;Few consumers are interested in a digital filing cabinet for their records. What they are interested in is what that data can do for them. Can it help them better manage their health and/or the health of a loved one? Will it help them make appointments? Will it saved them money on their health insurance bill, their next doctor visit? Can it help them automatically get a prescription refill? These are the basics that the vast majority of consumers want addressed first and Google Health was unable to deliver on any of these.â&#x20AC;?
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TECHNOLOGY
However, detailed analysis brought out a few important points that lead to the failure of Google Health:
through which the user could connect & easily transfer important information with their health care providers.
1. Ahead of its time. Google launched GH in the year of 2008. People at this time were still new to the concept of EHR, in fact, many had not even heard of it. Also, hospitals, clinics & health care portals in the US maintained a record of patients, such that they never felt the need to take charge of that data.
Now- a days many computer applications/ websites & devices that have sprouted, are filling the gaps left by google health . These apps are backed by their own back end systems & API’s, at the same time sharing with others.
2. Lack of Value Unless patients were suffering from chronic diseases, recurring medical problem or serious health issue, they never felt the need to use personal records. By the time many healthy patients had another occasion to use a PHR after it’s been set up, they probably had forgotten they even started a record and couldn’t be bothered. 3. Lack of 3rd party sourcing Thanks to social networking & smart phone technology, 3rd party sourcing has become a part of our every day DNA. But this was not the case with Google Health. Google had only allowed 3rd party sourcing from a handful of big name providers. It did not have any associations with labs, so consumers could not access their test results/ lab reports ( which is one of the key features of EHR ) 4. Lacked ancillary services Users could not contact their health care providers via secure messaging or schedule appointments. Services such as these could have added value to Google Health. Google concentrated more on giving features to users so that they could track their health records, viz a viz creating services
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5. Privacy and security concerns Fears about security and suspicion by some patients about whether Google Health had ulterior motives for collecting their health data was undoubtedly a factor that stopped some from using Google Health--or any online service for that matter--to store their personal health information.
Microsoft also had launched a similar initiative called “Health Vault”. Unlike Google Health, Health Vault has had a slow start, but is now catching up. This can mainly be attributed to its strategic 3rd Party tie-ups & availability on multiple-mobile platforms
Figure 11 : shows growth rate of smart phones source: Wikipedia
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TECHNOLOGY
MICROSOFT HEALTH VAULT
GOOGLE HEALTH
Microsoft Health Vault is a web-based platform from Microsoft to store and maintain health and fitness information.
Give people access to their personal health and wellness information
Addresses both individuals and health care professionals
Addresses individuals
Started in October 2007,
Started in 2008
PLATFORM:
PLATFORM:
FEATURES:
FEATURES:
t t
t t t t
-
t t t t t t t
www.healthvault.com (website) Health Vault Application
Store & maintain health & fitness information Access to a record may be authorized to multiple individuals, so that a mother may manage records for each of her children or a son may have access to his fatherâ&#x20AC;&#x2122;s record to help the father deal with medical issues. Track your medication/ prescription Connect with pharmacists Fitness & quit smoking progress trackers 3rd party tie-ups with medical applications such as: Diabetes PHA, Omron Blood Pressure Monitor, A&D blood pressure monitors. Available on mobile platform ( Health Vault Application ) Online health tools Safe guarded health information
-
t t
Website Synced with other Google services
Store & maintain health & fitness information Lack of access to authorized people Lack of 3rd party tie-ups Could track your fitness, but had to type manually into the computer Only available on web Security Issues left unclear
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SYNOPSIS A Summarizing my research on health care systems in India has led to some of the following observations :1.
Need for strengthening Public Sector
Many reputed public hospitals have suffered from lack of autonomy inadequate budgets for non-wage O&M leading to faltering and poorly motivated care. In the absence of a national regulatory body, some private providers practice without minimum standards and the quality of treatment varies from one provider to another. Emergence of corporate hospitals has led to increase in professionalism in medical practices and use of hospital management tools. With the adoption of technology, health care systems will become more transparent, effective & have a sense of integration. The National Rural Health Mission calls for a holistic approach to health development, supported by relevant human resource capacities, convergence, integration, and public-private partnerships. Government of India in its effort to increase accessibility to health care facilities is taking important initiatives of standardization of exchange of health information between different entities within the health care sector.
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2. Exponential increase in demand on existing health care resources The rate of growth of disposable income of middle & lower middle class is increasing. Health care being one of the basic needs of humans, will have to deliver solutions to cater to the growing expectations & needs of not just this segment but to all segments of the society. Currently, in India, private out-of-pocket expenditure dominates the cost financing health care. Rise of many private players from the health insurance sector will push the health care industry to adopt technology in all three sectors ( Primary- secondary- tertiary)
3.
Unaccountable Private sector
Given the commodification of medical care as part of a business plan private health care has not been regulated in terms of quality, accountability and fairness in care through criteria for accreditation, transparency in fees, medical audit, accountable record keeping, credible grievance procedures etc. Due to the monopoly of private players in urban India, common treatments, inexpensive diagnostic procedures and family medicine are replaced and priced out of the reach of most citizens.
DIPLOMA PROJECT > JUSTDIAL PVT LTD
4.
Telemedicine is growing
Lack of medical resources in many parts of rural India, has led to rapid adoption of advanced low- cost technological solution initiative led by Government & private institutions. The tele- medicine industry has grown to such a size that people from non- health care backgrounds are being recruited and trained. Though tele- medicine has impacted a very small percentage of the Indian population, the cost benefit analysis has shown that economic benefits to the patients have been far more than the investment.
5.
Penetration of mobile industry: A beacon of hope for increased Access to health care information
6.
Power to user
In the developed countries, approach of health care, changed hands from the hospitals to the hands of the users. This change can be attributed to sophisticated technology in every sector of health care. This trend is soon catching up in the Indian Urban segment that is catered by the corporate players. Few consumers are interested in a digital filing cabinet for their records. What they are interested in is what that data can do for them. Can it help them better manage their health and/or the health of a loved one? Will it help them make appointments? Will it saved them money on their health insurance bill, their next doctor visit? Can it help them automatically get a prescription refill?
If a medical service that can reach across the diverse geographical terrain of India, much like the penetration of mobile phones, & is available for the masses 24 * 7, even as guidance or of re-assurance value that a patientâ&#x20AC;&#x2122;s problem has been addressed to, it may have a great value in todayâ&#x20AC;&#x2122;s scenario. Increase in the demand & rise in adoption of smart-phones, has lead to new opportunities in innovative health care solutions customized for Indian markets.
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