Saturday, May 6, 2017

Healthcare Professional Education in the 21st Century

We need to radically change the way healthcare professional education is delivered.
Even twenty years back tertiary care hospitals were able to diagnose and treat complicated cases reasonably well, under one roof.
However, now the thrust is on wellness rather than illness. The majority of the patients suffers from NCDs (non-communicable diseases) and need long-term treatment and monitoring from home rather than in a hospital setting.
Information and Communications Technologies (ICT) is already enabling doctors, nurses, and patients to help each other. In the process, it is also facilitating primary care doctors to disrupt specialists, and for nurse practitioners to disrupt doctors.
The second role for ICT in transforming the cost and quality of health care is through the enhancement of medical records from pen and paper based to electronic forms or EMRs – ones that are portable, easily accessible, and interoperable. These can substantially reduce the costly paperwork that burdens today’s caregivers. Further, these will make it easier to avoid costly mistakes, and will enhance the involvement of patients in their own care.
In its most basic form, an electronic medical record (EMR) is simply the electronically stored version of what has always been recorded with pen and paper. However, the ability to customize and focus the personal health records or PHRs on consumer involvement may allow it to overcome many of the hurdles that have slowed the adoption of EMRs.
Unlike the US and Europe, in India, the EHRs have not yet been implemented extensively. That offers a regulatory advantage as the Health Ministry has come out with guidelines for adopting Standards. The National Health Policy 2017 has advocated a facilitating environment:

23. Digital Health Technology Eco – System: Recognising the integral role of technology(eHealth, mHealth, Cloud, Internet of things, wearables, etc) in the healthcare delivery, a National Digital Health Authority (NDHA) will be set up to regulate, develop and deploy digital health across the continuum of care. The policy advocates extensive deployment of digital tools for improving the efficiency and outcome of the healthcare system. The policy aims at an integrated health information system which serves the needs of all stake-holders and improves efficiency, transparency, and citizen experience. Delivery of better health outcomes in terms of access, quality, affordability, lowering of disease burden and efficient monitoring of health entitlements to citizens, is the goal.

The future world in which today’s health professional students will practice will be substantially different from the world for which the medical schools are preparing them. One difference is that many diseases that are in the realms of intuitive and empirical medicine today will have migrated toward the domain of precision medicine in 20 years. Therefore, many diseases will eventually be diagnosed and treated by clinical decision support systems, nurses and physician assistants. Organizing and supervising the work of allied health professionals will be a major dimension of
most of the physicians’ jobs.
Another difference can be perceived between personal versus process expertise. There will always be a need for deeply experienced, intuitively expert physicians to find complicated solutions. Many diseases will go on defying precision medicine, and new diseases will emerge. Today’s methods of preparing medical students to work as individuals is appropriate for those who will work in tertiary care hospital setups — though we will likely need fewer such physicians 30 years from now. But most of the physicians in the future will work in settings where much of the ability to deliver care will be better embedded in processes (clinical workflows) and in (smart) equipment, rather than exclusively resident in individuals’ capacities. Any medical college is yet to establish a health professional course in which students can learn how to design self-improving processes that prevent mistakes from occurring.

References
2.      EHR Standards

Thursday, May 26, 2016

Incorporation of Health Informatics in the curriculum for Healthcare Professionals

The art and science of processing “information” is informatics, where “information” is the processed “data” (anything that is observed and recorded). Just as we get information by “data processing”, using informatics tools, we condense information into “knowledge” that can be applied to real life situations.
When the informatics tools are applied to the “biomedical” field, it is called “biomedical informatics” which is a very broad term encompassing the study and application of computer science, information science, informatics, cognitive science and human-computer interaction in the practice of biological research, biomedical science, medicine and healthcare. Other fields, including bioinformatics (proteomics, genomics, and drug design), clinical informatics (including clinical research informatics), public health informatics and medical informatics (including imaging informatics, nursing informatics, dental informatics, pharmacy informatics, consumer health informatics, healthcare management informatics and veterinary informatics) are commonly counted as sub-domains within biomedical informatics.
Health or Healthcare informatics is an alternative term that has been defined: “If physiology literally means ‘the logic of life’, and pathology is ‘the logic of disease’, then health informatics is the logic of healthcare. It is the rational study of the way we think about patients, and the way that treatments are defined, selected and evolved. It is the study of how clinical knowledge is created, shaped, shared and applied. Ultimately, it is the study of how we organize ourselves to create and run healthcare organizations.”It deals with the resources, devices, and methods necessary for optimizing the acquisition, storage, retrieval, and optimal use of information in health and biomedicine. The health informatics tools include not only computers but also clinical guidelines, formal medical terminologies, and information and communication technology (ICT).
Biomedical / Health Informatics can be applied to diagnostic procedures, imaging, decision-support systems, patient records, financial and administrative systems, educational systems (for healthcare delivery students, practicing professionals and patients), patient monitoring (e.g., anaesthesia control), and accessing health knowledge.
The National eHealth Authority is in the process of being set up through an Act of Parliament. Under such circumstances, for the smooth adoption of eHealth throughout Digital India, there would be a tremendous requirement for formally trained health informatics professionals in India very soon. It will be prudent to incorporate health informatics as a part and also as a speciality for healthcare professionals in India. Ministry of Health and Family Welfare has notified Standards for Electronic Health Records since August 2013 and India has been a country member of IHTSDO that develops and maintains a terminology standards SNOMED-CT. It is essential to make healthcare professionals at all levels aware of such initiatives and adopt standards for health information exchange.
In the USA, all ABMS (American Board of Medical Specialties) member boards have agreed to allow their diplomates to take the clinical informatics subspecialty examination if they are otherwise eligible. The ABPM (American Board of Preventive Medicine) website provides information about eligibility for the exam and online application.Certification in Clinical Informatics is a joint and equal function of the ABP (American Board of Pathology) and the American Board of Preventive Medicine (ABPM).
CDC, Atlanta, Georgia, USA, offers PHIFP (Public Health Informatics Fellowship Program) as a 2-year, competency-based training program in public health informatics. The fellowship provides a problem-based learning environment in which fellows apply information and computer sciences and information technology to solve public health problems.
They have the opportunity to:
·         learn about informatics and public health in an applied setting
·         work with teams involved in research and development of public health information systems
·         lead an informatics project
·         design, develop, implement, evaluate, and manage public health information systems
References:
1.       Sarbadhikari SN, Medical Informatics: A Key Tool to Support Clinical Research and Evidence-based Medical Practice (Ch 15), In, Babu AN, Ed, Clinical Research Methodology and Evidence-based Medicine, 2nd Ed, 2015: 179-191.
2.       Abdel-Hamid T, Ankel F,…Sarbadhikari SN, et al, Public and health professionals’ misconceptions about the dynamics of body weight gain/loss, Syst. Dyn. Rev. 30, 2014: 58–74
3.       Ahmed Z, Sarbadhikari SN, et al., Using online social networks for increasing health literacy on oral health, Intl. J User Driven Health, 2013, 3: 51-58.
4.       Karishma SH,…, and Sarbadhikari SN, Creating Awareness for Using a Wiki to Promote Collaborative Health Professional Education, Intl. J User Driven Health, 2012, 2:18-28.
5.       Sarbadhikari SN, Unlearning and relearning in online health education, (Ch 21) In, Biswas R, and Martin C M, Ed, User Driven Healthcare and Narrative Medicine, IGI Global, Hershey, USA, 2011: 294 – 309.
6.       Sarbadhikari SN, How to Make Healthcare Delivery in India More “Informed”, Education for Health, Volume 23(2), August 2010: 456.
7.       Sarbadhikari SN and Gogia SB, An Overview of Education and Training of Medical Informatics in India, IMIA Yearbook of Medical Informatics, 2010: 106-108.
8.       Sarbadhikari SN, Applying health care informatics to improve student learning, Really Good Stuff, Medical Education, 2008; 42: 1117–1118.
9.       Sarbadhikari SN, How to design an effective e-learning course for medical education, Indian Journal of Medical Informatics. 2008; 3(1): 3: http://ijmi.org/index.php/ijmi/article/view/y08i1a3/15
10.    Sarbadhikari SN, The State of Medical Informatics in India: A Roadmap for optimal organization, J. Medical Systems, 2005, 29: 125-141.
11.    Sarbadhikari SN, Basic Medical Education must include Medical Informatics, Indian J Physiol. Pharamcol., 2004, 48(4): 395-408.
12.    Sarbadhikari SN, Guest Editorial on “Medical Informatics — Are the Doctors Ready?”,J.Indian Med. Assoc. , 1995, 93: 165 – 166.
13.     Mantas J,et al, Recommendations of the International Medical Informatics Association (IMIA) on Education in Biomedical and Health Informatics - 1stRevision, IMIA, 2009
14.     Burnette MH, De Groote SL, Dorsch JL. Medical informatics in the curriculum: development and delivery of an online elective. Journal of the Medical Library Association : JMLA. 2012;100(1):61-63. doi:10.3163/1536-5050.100.1.011.
16.     NHP, EHR Standards helpdesk: http://www.nhp.gov.in/ehr-standards-helpdesk_ms
17.     IHTSDO, SNOMED-CT: http://www.ihtsdo.org/member/india
18.    American Academy of Family Physicians, Recommended Curriculum Guidelines for Family Medicine Residents on Medical Informatics: http://www.aafp.org/dam/AAFP/documents/medical_education_residency/program_directors/Reprint288_Informatics.pdf
19.    AMIA, ABPM, ABP, Clinical Informatics Subspecialty Board Examination: https://www.amia.org/clinical-informatics-board-review-course/board-exam
20. CDC, Public Health Informatics Fellowship Program:http://www.cdc.gov/PHIFP/

Monday, November 16, 2015

Workshop on e-Learning for Health Professional Education

Here is a sample outlay:

Time
Activity
Logistics
13.30 to 15.00
Demonstration of some e-Learning platforms, followed by    activities on
      (a)  How to design an online Course?
      (b)  State the principles used

Laptop, LCD projector, Internet connectivity

Group Activity on flip charts
15.00 to 16.00  
Defining Netiquette, followed by activities on
     (a)  How to facilitate learning?
     (b)  How to enforce Netiquette?
Laptop, LCD projector, Internet connectivity

Group Activity on flip charts
16.00 to 17.00
Asking participants to look at the sample online discussions, then asking them to list the advantages and disadvantages of online discussion forums
Q&A Session for clearing doubts
Laptop, LCD projector, Internet connectivity

Group Activity on flip charts


Some platforms:
1. Moodle: https://moodle.org/
https://docs.moodle.org/29/en/Main_page
2. https://en.wikipedia.org/wiki/List_of_learning_management_systems

Examples of an online presentations:
1. http://www.pitt.edu/~super1/lecture/lec35331/
2. http://www.pitt.edu/~super1/lecture/lec43331/index.htm
3. Links to presntations in Youtube: https://sites.google.com/site/supten/

ADDIE Model: https://elearning.net/addie-instructional-design-model-overview-2/

Netiquette:
1. http://www.ncbi.nlm.nih.gov/pubmed/17425016
2. http://www.ncbi.nlm.nih.gov/pubmed/17614893

Some examples of online interactions:
1. http://www.udhc.co.in/INPUT/displayIssueGraphically.jsp?topic_id=1066
2. http://www.udhc.co.in/INPUT/displayIssueGraphically.jsp?topic_id=1732


Wednesday, March 18, 2015

Stakeholder Consultations for NeHA Concept Note

India is planning to move towards “Digital India” and Technology for Health – e-Healthcare is mentioned in the proposed 5th Pillar of eKranti. The stress is on pan-India healthcare information exchange and services, like online medical consultation and medicine supply with a focus on electronic health / medical records (EHR / EMR).
The Ministry of Health and Family Welfare (MoHFW), Government of India, had notified the Guidelines for EHR Standards in September 2013, and had also become a Country Member of IHTSDO for using SNOMED-CT (a global standard for medical vocabulary) in April 2014. However, India is yet to have a National eHealth Strategy or Policy.

Currently the MoHFW is in the process of setting up the National eHealth Authority (NeHA). Once the NeHA is set up, the first priority for it should be to formulate a National eHealth Strategy or Policy, in consultation with all the stakeholders – the general public, state governments, healthcare providers, health information technology vendors, and academicians. It will be prudent to have a robust National eHealth Strategy to facilitate smooth adoption of eHealth in India. Presently (by 20th April 2015) the MoHFW is inviting comments from all the stakeholders on the Concept Note of NeHA. Let us hope that everyone sends in adequate inputs to formalize the concept and to quickly make the NeHA a necessary and useful reality. The earlier the NeHA is set up, the better it will be for integrating the diverse ICT efforts (by the Central and State governments, as well as the various private players) for delivering healthcare to all.




Thursday, December 11, 2014

Proper way to implement ICT tools for the National Health Assurance Mission (NHAM)


What practical steps can a country take to begin to develop a NeSF (National eHealth Standards Framework) that supports health care delivery and UHC initiatives? The following are recommended by Ritz, Althauser and Wilson [2014] as useful, actionable steps:

1. Storyboard: Develop a set of characteristic user stories that illustrate both the care workflows and the health insurance workflows common to the country. These stories should be aligned with the country’s health strategic goals (e.g., if improving maternal health outcomes is a strategic goal for the health ministry, draft stories describing maternal care delivery activities).

2. Stack: Based on the requirements and the constraints in the country, choose a “stack of standards.” [MoHFW, Government of India has already notified the Standards for EHR in India in August 2013. The National Health Portal also offers a Help Desk for that.]

3. Scope: Narrow the initial implementation scope and grow the scope over time. Any country embarking on a national-scale eHealth infrastructure effort will be well served by focusing on a few key areas. [A “crawl, walk, run” strategy “from the essential to the optimal” is more practical.]

Keeping the above recommendations in mind, India needs to incorporate the NeSF within its National eHealth Strategy / Policy (NeHS/NeHP) that has to be formulated by the Proposed National eHealth Authority (NeHA). It will be good if the NeHA is set up immediately so that the NeHS/NeHP for India can be outlined, in consultation with all the stakeholders, especially the state governments, as Health is a State subject in India. India’s NeHS/NeHP has to be aligned with the National Health Policy, Digital India initiatives, as well as the proposed National Health Assurance Mission (NHAM) policies, so that a focused and judicious use of ICT can make the healthcare delivery systems more efficient and transparent. It will be good to build the ICT policies of NHAM upon the existing ICT mechanisms of the National Health Mission (NHM) and the Rashtriya Swasthya Bima Yojana (RSBY) instead of reinventing the wheels.

Thursday, August 7, 2014

Immediate Need for the National eHealth Authority of India (NeHAI)

The National eHealth Authority of India (NeHAI) should be set up immediately to formulate the National eHealth Strategy (NeHS) for India and to initiate the necessary capacity building. It requires creating and sustaining multi-disciplinary teams of people with the right mix of clinical, technical, managerial and organizational skills. Sometimes engaging marketing experts and establishing a good service infrastructure to support eHealth services, e.g., to citizens, will be essential.
It should have the following:

Vision / Goals:
       To guide the adoption of e-Health solutions of national and state importance for India, and,
       To facilitate the implementation of e-Health by integrating and harmonizing the standards for health information exchange in India

It is often said that neither ICT applications, nor information by itself bring benefits. The gains can come from changes in processes or working practices that are more substantial than replacing paper with an electronic document, which may have been the trigger to benefit realization. 
For more complex eHealth investments, these multi-disciplinary teams should include people who themselves, have a multi-disciplinary background. Having completed the process, their extensive knowledge and expertise in this field have been enhanced by the experience.

Outcomes and Impact of eHealth:
  • Improved timeliness (better quality of healthcare delivery)
  • Effectiveness (right intervention / audit trails for adverse events)
  • Efficiency (less resources in terms of manpower, time and cost)
  • Informed patients and their caregivers
  • Better access


§Benefits of “asynchronous telehealth”:
§  Diagnostic accuracy,
§  Reduced waiting times,
§  Better referral management and
§  Greater satisfaction with services
§With the worldwide explosion in the use of mobile phones and mobile Internet, Behavioral changes needed foe benefitting health can be through
§  SMS-based services,
§  Live and asynchronous telemedicine, and
§  Interactive voice response  service (IVRS)


Reasons for Urgency and Alternatives:
  • The National Knowledge Commission (NKC) had recommended formation of National Health Information Authority (NHIA) in 2008. It has not been set up in these 6 years.
  • Currently DPR for Mission Mode Project (Health) is about to be finalized and that recommends formation of the Authority (NHIA / NeHAI). However, the National eHealth Strategy (NeHS) is yet to be formulated. Once NeHAI is in place, the NeHS can ensure smooth adoption of eHealth throughout the country by formulating a robust NeHS.
  • EHR Standards have been notified by MoHFW in September 2013 without any guiding NeHS from NeHAI. Therefore, lots of parallel non-interoperable eHealth activities are being undertaken in various states by both public and private healthcare providers.
  • MoHFW has paid for India to be a member country and has the national license of SNOMED-CT since April 2014. However, SNOMED-CT is yet to be available for free public access in India as a membership benefit. Initially CBHI was supposed to be the National Release Centre (NRC) for SNOMED-CT. Now C-DAC, Pune has been temporarily made the NRC till the time NeHAI is set up. The SNOMED-CT is still not publicly accessible.
  • Process for Cabinet note preparation for NeHAI (10 months’ timeline) has been started as it was in the Election Manifesto 2014 of BJP.                                      
  • To address the above points, 
  • Immediate Executive Order may be passed to set up NeHAI, or,
  • A post may be created for “Advisor to the PM for eHealth” to guide and expedite the whole process.

Monday, February 20, 2012

Career options in Health Informatics

I have uploaded a small presentation on this topic at YouTube.
After having a look at it, if you have any queries, please feel free to contact me at SUPTEN [AT] GMAIL [DOT] COM.
You may also visit the Institute Wiki.