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ICT for Health: Networks, standards and innovation

However, the experience validates that the data that is needed Disease Control Programme (NVBDCP) &National
in the first place for the knowledge management system to Tuberculosis Control Programme (https://nikshay.in/)
work is either not available or recorded and stored in c. Electronic Medical Records (EMRs) including
isolation. Addressing the various issues in the public health the Mother Child Tracking System and Reproductive Child
sector, amongst other factors, include the need for more Health Register
collaborative inter-sectoral engagement, ‘buy-in’ from the d. Clinical decision support system (CDSS):radio-
political authorities and decision makers etc. To resolve diagnostics and laboratories
these concerns, Thailand, in the 1990s, had adopted a e. Computerized physician order entry:secondary
paradigm called "Triangle that Moves the Mountain" [13]. and tertiary care private institutions
‘The Mountain’ means a big and complicated problem, f. Online registry system for patients’
usually unmovable. ‘The Triangle’ consists of: creation of appointments:e-hospitals (ehospital.gov.in)
relevant knowledge through research, social movement or g. Applications based on electronic health records:
social learning, and political involvement. The three PM JAY, national health insurance
components of the triangle have to work together in tandem (https://www.pmjay.gov.in/)
to achieve the goals of resolving the health issues. This has
resulted in the near elimination of the uninsured with its The most popular of these initiatives is the HMIS, which is
universal health coverage, elevated almost a million Thai an online portal that provides information on the human
citizens from poverty while strengthening the capacity of health indicators in the country. It is a tool that provides a
knowledge generation and management [14]. This approach framework for gathering the raw data from primary care
can form a remarkable basis for evolving a structure and health institutions upwards at state level from primary health
systematic approach for building a KM system for any centers (PHCs) onwards. This data is then compiled at block
vertical including health. Some instances of best application level, district level and finally at the state HQ level before
of knowledge management using ICT in public health with feeding into the national level database. Data aggregation
varying degrees of implementation have been observed in a units are at block and district level. The flow of data is
number of countries, notably Canada, Germany, New upwards as well as downwards. HMIS also compiles data
Zealand, South Korea and the U.S.A [14]. from the National Family Health Survey (NFHS), the
District Level Household Survey (DLHS), and the Office of
3. A CASE STUDY FROM INDIA: HMIS AND the Registrar General and Census Commissioner, among
OTHER SYSTEMS HAVING LINKAGES WITH other sources [17]. The information generated from this
PUBLIC HEALTH analysis is then used for taking actions that help in improving
health outcomes. The Online Registry System (ORS) for
India is a country with a vast requirement for a stable public patients is a framework that links various hospitals across the
healthcare system due to its complex health needs of over a country for the Aadhaar-based (biometric digital identity)
billion people with diverse social, economic, geographical online registration and appointment system, where the
and cultural context. Despite its rapid economic growth, it counter-based outpatient department (OPD) registration and
has been ranked 143 in a list of 188 countries in the ‘Health appointment system through HMIS has been digitized. At the
rd
Related SDG’ index that aims to assess each country’s end of June 2019, 230 hospitals across the country are using
performance across 33 indicators in a global burden of ORS [18].
disease (GBD) study [15]. Also, according to another GBD
study published in the medical journal The Lancet, India has The Integrated Disease Surveillance Programme (IDSP) was
finished 154 among 195 countries on the healthcare index, launched in 2004 by the National Centre for Disease Control
th
which is based on death rates for 32 diseases that can be (NCDC), India. The program continues under National
avoided or effectively treated with proper medical care [16]. Health Mission with the objective to strengthen/maintain the
These rankings are a cue enough for revamping existing decentralized laboratory-based information technology (IT)-
approaches towards public healthcare systems. Before the enabled disease surveillance system for epidemic-prone
study moves ahead to propose a KMS conceptual model to diseases to monitor disease trends and to detect and respond
address these public health concerns, it might be more to outbreaks in early rising phase through trained rapid
prudent to first enumerate strides that the country has made response teams (RRTs). Under the program, surveillance
in this direction. units have been established in all districts of the country and
it collects data on disease outbreaks for the country as a
At present, a number of health management systems (HMS) whole, excluding non-communicable diseases.
by the public sector are operational in the country that can be
categorized as follows. Similarly, there are other systems being maintained by
different government institutions that are collecting data,
a. Performance reporting portal including the which have implications on PH but are not connected to the
Health Management Information System (HMIS), National HMIS. A case in point is the All India Network Project on
Health Portal (https://www.nhp.gov.in/) andState Health Pesticide Residues (AINPPR). The laboratories under the
Programportals network collect the samples from the nearby Agriculture
b. Disease surveillance portal including Integrated Produce Marketing Corporation (APMC) markets and
Disease Surveillance Programme, National Vector Borne analyze for the possible residues of the pesticide and since

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