Suggestions to improve Health Services to the common Man

 Some observations on Primary Healthcare

In a 2005 study, World Bank reports that "a detailed survey of the knowledge of medical practitioners for treating five common conditions in Delhi found that the typical quality doctor in a public primary health center

– has a more than 50-50 chance of recommending a harmful treatment".

Unannounced visits by government inspectors showed that

– 40% of public sector medical workers could not be found at the workplace.

•This has lead to wide spread success of Rajiv Aarogya Shree (access and choice)

Current Issues faced by patients• Advice the patients where to go and what to do

• Waiting time, patients often wait in less than desirable places like waiting halls for a day or two if not for a few hours

• The burden of organizing and maintaining relevant medical records is on the patients(who are often poor and uneducated)

• Hospitals both private and public operate independently, the makes referral system very informal and erratic and often unplanned

• Patient or the referring is often unable to make the best choice of specialist convenient for all due to absence of any information network.

• Recording a sequence of events, for future diagnosis and reference especially for chronic care

Solution is Health Information Exchange

Health Information Exchange

EMREMR

Global experiences

US: Prescription error, Low EMR information interoperability,Low EMR adoption.Since 2004 there is federally mandated push for EMR adoptionSince 2009 greater emphasis on interoperability as well.

Canada: Moderately high level of EMR adoption, GPs have seen about 22% increase in throughput (Productivity tool)

Africa: Mashavu - networked healthcare (closest to our rural need) using gps/internet and computers

Denmark: Vibrant Fully integrated Healthcare Information Exchange. About 20% savings in cost post national network.

 Silos of operation

All too often, government planners, business executives, and nonprofit organizations have operated at cross-purpose.

Benefits of EMR to our people

• More efficient and transparent healthcare to downtrodden – A fundamental need

• Reduction in travel by patients• Early disease pattern detection• Enabling preventive care• Elimination of paperwork hassles by patients• PHCs to be nodal point to be reinforced• Targeted disease cure• Avoid prescription errors• Targeted specialist referrals• Ease stress on specialist doctors• Peer reviewed standard operating procedure• Establish standard operating procedures for treatment• Monitor Child health• Allow pharmacy to better target patient need• Reduce spurious drugs in the system• Large scale micro customization• Transition from transaction base care to health indicator monitoring• Incentivize GPs to improve health rather than just treat disease (GP

incentive programme in UK)

Recent events

• Rajiv Aarogya Shree programme by Govt of APo led to investment by private sector in healthcare infrastructureo AP in on the verge of becoming a leader in terms of modern

healthcare infrastructure o But it does not address preventive healthcareo this gives us a means to get all the providers of healthcare under

one pervasive network

Policy Makers

Drug Makers

Education

Current Patient Information Flow

Patient

Doctor

Health Department / Govt

Drug Stores

Drug ManufacturersHealth Insurance

Diagnostic Centers

Non-Coordinated Information Flow

Target Patient Information Flow

EMR EMRPatient

Doctor

Health Department / Govt

Drug Stores

Drug ManufacturersHealth Insurance

Diagnostic Centres

Streamlined Information Flow

Aarogya Shree

• A boon for poor• The current program is transaction based which is

effective to make high skill/cost treatment available to the poor for free.

• The program should work backward and integrate itself with preventive healthcare

• Primary Healthcare Centre (PHC) can transform itself to include preventive healthcare in their delivery

• Establish peer reviewed standard operating procedures

Why preventive healthcare

• Make GPs more effective and relevant to patient

• Ease the burden on traditional transactional healthcare system which is effective for treatment

• Monitor patients with lifelong health issues like hypertension, diabetes etc

• Address local ailments like fluorosis

• Preventive Care Saves Money -- not just for the government but of the patients as well (higher productivity)

How do we begin• Pilot project

– 1 district covering 1 hospital, corresponding PHCs(Primary Health Centre) and selected diagnostic centres

– Master Data creation for patients who report to the hospital and PHCs

– Prototype application development to cover the scope of pilot project

– Connectivity between PHCs and hospitals with pilot head quarters

– Hardware – We suggest cloud to avoid hardware infrastructure investment for the pilot

– Data Entry operators with thin clients(computers)

Summary

• "Can you imagine going to your bank and having them write out your account, keeping track of it by pen and paper, and then you go to another bank and they don't have that record? We wouldn't tolerate it, so why do we tolerate it in a health-care system that doesn't have the most basic thing, which is a national electronic medical records system?“

References

• http://www.govtech.com/gt/374043