Thursday, January 11, 2018

The Role of Change Management and Capacity Building for the smooth adoption of Digital Health in India

Digital health electronically connects the points of care so that health information can be shared securely to help deliver safer, better quality healthcare.
The broad scope of Digital Health includes categories such as mobile health (mHealth), health information technology (IT), wearable devices, telehealth and telemedicine, and personalized medicine. Digital health is about electronically connecting the points of care so that health information can be shared securely. This is the first step to understanding how digital health can help deliver safer, better quality healthcare.
Health Information Management (HIM) professionals are well trained in the latest information management technology applications and understand the workflow in any health care provider organization. Health Information Managers are vital to the daily operations management of health information and electronic health records (EHRs). They ensure that Data Quality is maintained, by applying the principles of Change Management and continuous capacity building through education and training. They ensure that the health information and records of a patient are complete, accurate, protected and meet the desired and stipulated medical, legal and ethical standards. Therefore, it must be made mandatory to appoint an adequate number of health information managers, according to the size of the healthcare organization, to ensure safe and smooth adoption of digital health in India, leading to informed healthcare delivery.
These professionals affect the quality of patient information and patient care at every point in the health care delivery cycle. They work on the classification of diseases and treatments to ensure they are standardized for clinical, financial, and legal uses in health care. HIM professionals care for patients by caring for their medical data. This, in turn, leads to informed healthcare delivery, especially when and where the information is translated into actionable outputs.
I have been tracing the evolution of health informatics and health information managers in making healthcare delivery more informed. Further they also show the role of unlearning and relearning in effectively assimilating information for better healthcare delivery.
As the Indian government aims for Universal Health Coverage (UHC), the lack of skilled human resource may prove to be the biggest impediment in its path to achieve targeted goals. Therefore, the model curriculum handbook on health information management has been designed with a focus on performance-based outcomes pertaining to different levels. The learning goals and objectives of the undergraduate and graduate education program are based on the performance expectations. These are articulated as learning goals and learning objectives. Using this framework, students will learn to integrate their knowledge, skills and abilities in a hands-on manner in a professional healthcare setting. These learning goals are divided into nine key areas, though the degree of required involvement may differ across various levels of qualification and professional cadres:

1. Clinical care
2. Communication
3. Membership of a multidisciplinary health team
4. Ethics and accountability at all levels (clinical, professional, personal and social)
5. Commitment to professional excellence
6. Leadership and mentorship
7. Social accountability and responsibility
8. Scientific attitude and scholarship (only at higher level- PhD)
9. Lifelong learning

Among these nine core competencies, the third one (Membership of a multidisciplinary health team) is perhaps the most important. The student will learn to put a high value on effective communication within the team, including transparency about aims, decisions, uncertainty and mistakes. Team-based health care is the provision of health services to individuals, families, and/or their communities by at least two health providers who work collaboratively to accomplish shared goals within and across settings to achieve coordinated, high quality care. Program objectives will aim at making the students being able to:
Ø  Recognize, clearly articulate, understand and support shared goals in the team that reflect patient and family priorities
Ø  Possess distinct roles within the team; to have clear expectations for each member’s functions, responsibilities, and accountabilities, which in turn optimizes the team’s efficiency and makes it possible for them to use division of labor advantageously, and accomplish more than the sum of its parts
Ø  Develop mutual trust within the team to create strong norms of reciprocity and greater opportunities for shared achievement
Ø  Communicate effectively so that the team prioritizes and continuously refines its communication channels creating an environment of general and specific understanding
Ø  Recognize measurable processes and outcomes, so that the individual and team can agree on and implement reliable and timely feedback on successes and failures in both the team’s functioning and the achievement of their goals. These can then be used to track and improve performance immediately and over time.

As this model curriculum is competency-based, it connects the dots between the ‘know what’ and ‘do how’ for HIM professionals.
The National Health Policy-2017 advocates extensive deployment of digital tools for improving the efficiency and outcome of the healthcare system. The policy aims at an integrated health information platform or 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. Establishing federated national health information architecture, to roll-out and link systems across public and private health providers at State and national levels consistent with Metadata and Data Standards (MDDS) and Electronic Health Record (EHR) Standards, will be supported by this policy. The policy suggests exploring the use of “Aadhaar” (Unique ID or UID) for identification. Creation of registries (i.e. patients, provider, service, diseases, document and event) for enhanced public health/big data analytics, creation of health information exchange platform and national health information network, use of National Optical Fiber Network (NOFN), use of smart phones/tablets for capturing real time data, are key strategies of the National Health Information Architecture. The policy advocates scaling of various initiatives in the area of tele-consultation which will entail linking tertiary care institutions (medical colleges) to District and Sub-district hospitals which provide secondary care facilities, for the purpose of specialist consultations. The policy will promote utilization of National Knowledge Network (NKN) for Tele-education, Tele-CME, Tele-consultations and access to digital library.
The National Health Policy 2017 of India states that recognizing the integral role of technology (eHealth, mHealth, Cloud, Internet of Things or IoT, wearables) 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.
Currently, in the International Institute of Health Management Research, New Delhi,  I am involved in training such professionals through a regular 2-year PGDHM (Post Graduate Diploma in Health and Hospital Management) course that is equivalent to MBA, as per the Association of Indian Universities (AIU), and also through short-term Management Development Programs (MDP) for in-service professionals.
To conclude, HIM professionals are very well trained and suited to ensure that the health information and records (EHRs) of a patient are complete, accurate, protected and meet the desired and stipulated medical, legal and ethical standards. Therefore, it must be made mandatory to appoint an adequate number of health information managers, according to the size of the healthcare organization, to ensure safe and smooth adoption of digital health in India, leading to informed and safer healthcare delivery. 

2 comments:

  1. The article has very subtly described the requirement and steps needed for effective implementation of digital health in India. The policy think tank would do well to incorporate the change scheduled so well articulated, though, the change in itself may not be easy to usher. A very poignant article with a good insight. Recommended strongly for the tommorrow's health managers.

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