National E-health Mission

Arumukham Gopalan, a farmer in Kerala, had his cardiac profile tested three times last year. Each time, the tests led to varied diagnoses and inconsistent treatment by assigned doctors at the same hospital. Gopalan underwent different procedures during that time, not realising that his treatment had only helped to boost his medical bills and not his health. This cost him a lot of time too. And finally, he had to undergo an emergency open heart surgery at a critical condition which took all his life savings.

The case of Sharad Totla was worse. Totla, a taxi driver in Mumbai, died because of faulty diagnosis and treatment that aggravated a pre-existing condition of liver cirrhosis.

Gopalan and Totla are just two of the millions of victims of medical negligence in India, which has no proper system in place to keep records of patients for cross referencing — most crucial for error-free treatment. Keeping medical records can not only help in avoiding repeated tests, it also makes healthcare delivery practices more transparent and affordable. But currently, there is no internal mechanism that hospitals follow in this regard, hence no records are available for inter-hospital references.

Creating an integrated health information system, by collaborating data from across hospitals in India — which can also help in formulating national health policies and setting medical standards — is thus the need of the hour. A well-connected information and communication technology platform that can inter-operate across various stakeholders, including healthcare providers both in public and private sectors can go a long way in preventing medical negligence. Such a platform with a set of regulatory standards to ensure quality services and patient privacy will be beneficial for all stakeholders.

An ambitious project
Almost a year after the Modi government came to power at the centre, the ministry of health and family welfare unveiled a concept note announcing its plans for a National eHealth Authority (NeHA) under the marquee ‘Digital India’ campaign. The promotional and regulatory body, it said, would guide and support India’s journey in e-health and leverage the benefits of information and communication technology (ICT) intervention to put the country’s ailing health sector in order.

The government’s proposal also clearly spelt out the proposed functions and governance mechanism of the e-health body, which drew from global experience and earlier recommendations of advisory bodies including the National Knowledge Commission.

The government strongly recommended that the authority be established at the earliest, as it will give a fillip to all the current and envisaged programs of the government in respect of information technology in the area of healthcare. It is also expected to accelerate adoption of electronic health records, which is significantly important for improved healthcare and churning the big data for policy purposes in an orderly manner. More importantly, it can help in avoiding problems arising out of uncoordinated induction of IT systems, in hospitals and public health systems, which will become inevitable in the future.

According to senior officials at the ministry of health, the proposal has now moved to action after multiple rounds of discussions with various stakeholders.“The ministry is moving ahead with the proposal. One of the joint secretaries has also been assigned with the process of formalising the structure,” says Jagdish Prasad, director general of health services, India.

Unhealthy India
India currently spends around 4.1 per cent of its gross domestic product (GDP) on health. But the contribution from the government is just about 1.1 per cent of the overall spend. Since the insurance penetration is low, the out-of-pocket expenses for patients are very high; it is estimated at more than 60 per cent, which is perhaps the highest in the world.

The country’s health statistics on basic parameters say it all. India’s life expectancy stands at 66 years in both male and female population and infant mortality rate under five is still high at 43.8 in males and 56 among females per 1,000 live births. The maternal mortality ratio currently stands at 190 per 1,00,000 live births.

Several recent interventions have helped in eradicating polio and reducing the prevalence of HIV, malaria and tuberculosis. Yet, the country’s adult mortality rate or the probability of dying between 15 and 60 years per 1,000 lives stands at 242 for men and 160 for women.

In India, deaths due to communicable diseases, maternal, perinatal and nutritional conditions account for 28 per cent and, due to injuries and non-communicable diseases account for 12 per cent and 60 per cent, respectively.

World Health Organisation’s latest country estimates on disease and injury indicate that India loses 22,750 to 29,500 life-years out of 1,00,000 life-years due to several causes. Of which, non-communicable diseases including cardiovascular, diabetes, etc., account for 43 per cent.

India scores low in terms of utilisation of health services in comparison with other world countries. At the same time, adult risk factors remain high on account of tobacco use, raised blood pressure and glucose, among others.

While the percentage of population using clean water has risen to about 95 per cent, the situation remains poor in respect of using improved sanitation at less than 40 per cent. Over and above these challenges, Indian healthcare system suffers from acute shortage of physicians and quality paramedics, and the situation is much worse in rural areas.

“Given that India today enjoys a demographic dividend which can contribute to productivity and prosperity of the nation, the healthcare system is specially and fundamentally important to the country from both an economic and social perspective,” admits the ministry of health and family welfare in the concept note on National e-Health Authority.

And, there’s no denying that a healthy population underpins strong economic growth, community well-being and prosperity.

Technology is critical
Technology can play an enabling role in addressing the issue of absence of qualified service delivery personnel in remote areas; improving the efficiency of the healthcare system; and also bettering the quality of care. For the change to happen, however, it will require a fundamental shift in the way information is accessed and shared across the healthcare system.

The country needs to move away from tools such as pen, paper and human memory to an environment where beneficiaries, providers and healthcare managers or administrators can reliably and securely access and share health information in real time across geographic and health sector boundaries.

“The only way this can be achieved is through the implementation of world class ICT interventions and adoption of e-health,” says the government note.

“The centre’s move to set up an authority to monitor and ensure quality processes of technology (information technology) intervention in the Indian healthcare system is a very positive step as the country has no other option but to use technology to address several issues that currently prevent quality delivery and access to healthcare services,” says, Muralidharan Nair, leader, healthcare practices at Ernst and Young India.

Fortunately, some of the premier hospitals in the government sector and many of the corporate hospitals are equipped with e-health compatible platforms; they have started creating electronic records on patient history, diagnostics and treatment protocol for internal purpose. Since India is a fast-emerging market for healthcare IT companies (both homegrown and global), several local and international players in the space, including medical technology giants such as GE, Siemens and Philips, have already started exploring these opportunities.

“The government’s e-health project, including the establishment of the authority, which is slated to be formalised by early 2017, will certainly open up a much larger market opportunity for both healthcare providers as well as healthcare IT players in India,” says Rajendra Pratap Gupta, advisor to union health minister and the author of the bestseller book Healthcare Reforms in India.

That said, an extended budget allocation and committed execution will be crucial for the e-health project to succeed. Will the government walk the talk?

unni@businessworld.in
@unni_ch