Professional Education for Digital Health

The term digital health is rooted in eHealth, which is defined as “the use of information and communications technology in support of health and health-related fields”. Mobile health (mHealth) is a subset of eHealth and is defined as “the use of mobile wireless technologies for public health”.

The newly proposed Global Strategy for Digital Health from the WHO is trying to define Digital Health as “the field of knowledge and practice associated with any aspect of adopting digital technologies to improve health, from inception to operation.”

Digital health interventions are applied within a country context and a health system, and their implementation is made possible by a number of factors. These include:

     (i)            the health domain area and associated content;

   (ii)            the digital intervention itself (i.e. the functionality provided);

 (iii)            the hardware, software and communication channels for delivering the digital health intervention; and, mediated within

 (iv)            a foundational layer of the ICT and enabling environment, characterized by the country infrastructure, leadership and governance, strategy and investment, legislation and policy compliance, workforce, standards and interoperability, and common services and other applications.

The National Health Policy 2017 (NHP-2017) of India correctly identified the need for creating many new institutions like the National Digital Health Authority (NDHA). Also, Health informatics education must be embedded as an integral part for health and hospital management. That will ensure a smooth adoption of digital health in India. India will then be recognized as a significant global player in digital health.

India has hosted the 4^th Global Digital Health Partnership Summit and the International Digital Health Symposium in the last week of February 2019. This also shows the commitment of India towards strengthening Digital Health Globally. Here the “Delhi Declaration” was adopted to accelerate and implement the appropriate Digital Health interventions to improve health of the population at national and sub-national levels, as appropriate according to national context.

Soon after, on 16^th April 2019, the World Health Organization (WHO) has released its recommendations of ten ways that countries can use digital technologies that people can improve their lives and essential services. Therefore, there is an imminent need for people, trained in digital health management, who can confidently handle a multitude of software services and help medical professionals, hospitals, healthcare organizations and common people. Courses on digital health are very new even globally and the career opportunities for early entrants are enormous.

Here I propose a 2-day or 12-hour interactive modular course for initiating health professional educators and administrators to the concepts and practice of digital health. I have been offering this course on-site, with suitable customization according to the needs of the institutes.

Course Objectives and Competencies

References

1.  Sarbadhikari SN, Sood JM. Gamification for nurturing healthy habits. Natl Med J India 2018; 31: 253-4 / Sarbadhikari SN, Sood JM. Gamification for nurturing healthy habits. Natl Med J India Available from: http://www.nmji.in/text.asp?2018/31/4/253/258236
2. Sarbadhikari SN, Will Health Informatics gain its rightful place for ushering in Digital India?, Indian Journal of Community Medicine, 2018, 43 (2): 126–127.
3. Sarbadhikari SN & Srinivas M, Health Informatics and Health Information Management, In, Gyani G & Thomas A, Eds, Handbook of Healthcare Quality and Patient Safety, Jaypee, New Delhi, 2^nded, 2016, Sec. 4, Ch. 17: 206-216.
4. 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, 2^nd Ed, 2015: 179-191.
5. Balsari S, Fortenko A, Blaya JA, Gropper A, Jayaram M, Matthan R, Sahasranam R, Shankar M, Sarbadhikari SN, Bierer BE, Mandl KD, Mehendale S and Khanna T. Re-imagining health data exchange: An API-enabled roadmap for India. J Med Internet Res [Impact Factor 4.7], 2018. doi:10.2196/10725.
6. Ministry of Health and Family Welfare, Government of India, National Health Policy 2017. Available from: https://www.nhp.gov.in//NHPfiles/national_health_policy_2017.pdf
7. Sarbadhikari SN. Digital health in India – As envisaged by the National Health Policy (2017). BLDE Univ J Health Sci 2019;4: [In Press]
8. Sarbadhikari SN. Available from: https://blog.hcitexpert.com/2018/04/how-can-digital-health-be-implemented-in-NHP2017-Prof-Supten-Sarbadhikari.html - republished with permission from: http://supten.blogspot.com/2018/03/how-can-digital-health-be-implemented.html
9. National Health Portal, Ministry of Health and Family Welfare, Government of India, EHR Standards. Available from: https://www.nhp.gov.in/ehr-standards-helpdesk_ms
10. Ministry of Health and Family Welfare, Government of India and World Health Organization, India. Available from: https://www.gdhpindia.org/
11. Global Digital Health Partnership, Delhi Declaration, Available from: https://s3-ap-southeast-2.amazonaws.com/ehq-production-australia/25eb0facd90ee547c03071b005807288dbeac40b/documents/attachments/000/099/429/original/GDHP-Delhi_Declaration_Final.pdf?1551307009
12. World Health Organization; WHO guideline: recommendations on digital interventions for health system strengthening. Geneva: 2019. Available from: https://apps.who.int/iris/bitstream/handle/10665/311941/9789241550505-eng.pdf

“National” in my life!

After completing my +2 from St. Lawrence High School, I got admission to Calcutta National Medical College in 1984. Our classes started on the auspicious occasion of Teachers’ Day viz., 5^th September.

During my college years, I was fortunate to become the Senior Class Assistant in Physiology and Junior Class Assistant in OBG. Apart from that I also used to participate and conduct quizzes, and, conduct many perpendicular events during AGON. Along with Anindya Chaudhuri, I had represented our college in the very first Quiz Time (1985) conducted by Siddharth Basu in Door Darshan.

By the time we passed out, by July 1989, and then completed our internship, by July 1990, most of us were sure of our possible future careers.

Although I did house job (junior residency) in General (Internal) Medicine from August 1990 to July 1991, that discipline was my seventh career option! Somehow or other I felt that those twelve months were the best in my life. Later on I penned down that experience in a booklet – “হাসপাতালে একবছর” from মনফিকরা (July 2016).

Psychiatry was higher in my option list so I went to the Central Institute of Psychiatry, Kanke, Ranchi for junior residency during August – September 1991.

However, my topmost option was making a career in medical informatics. Unfortunately, in the early 90s, there was no training available for informatics in India. The foreign institutes that I wrote to wanted me to know the basics of computers. So I was thinking of getting enrolled in NIIT.

Meanwhile, the School of Biomedical Engineering, Institute of Technology, Banaras Hindu University, (then IT-BHU, now IIT-BHU), Varanasi was offering Senior Research Fellowships to MBBS graduates for pursuing PhD in Biomedical Engineering. Fortunately, I was selected to join the institute in October 1991 and got registered for the PhD from the session of March 1992. I could choose my PhD topic related to development of an (artificial neural network based) clinical decision support system for depression.

During this period (March 1992 – March 1995), I once came to visit our Alma Mater and met many of our teachers. One of the teachers whom I met, used to love me a lot, especially since Amit Behl and myself had represented our college twice – in the 4^th and 5^th years, in the Nestle Pediatric Quiz. He asked me that since now I am pursuing PhD in Biomedical Engineering, what will I do after that? I answered that I don’t know. I was shocked by his response to my answer. Generally a mild spoken person, he got very angry and told me that I should have never chosen a career where the future is uncertain!

I submitted my PhD thesis in March 1995 and was invited to write a Guest Editorial for JIMA (Journal of the Indian Medical Association). I wrote in May 1995 [Vol. 93(5): pp.165-6. PubMed PMID: 8834135] – Medical informatics – are the doctors ready?

Meanwhile I joined the Machine Intelligence Unit of Indian Statistical Institute in Calcutta as a Research Associate in a CSIR project under Prof. Sankar K Pal. Subsequently, I also did general practice in Durgapur for about a year and half, while my better half Dr. Anindya was a Medical Officer in CRPF, posted in Durgapur. I did a couple of short term contract jobs with South Eastern Railways and Bankura Sammilani Medical College during 1998-99.

The first formal academic job that I got was in Sikkim Manipal University from January 2000 I had joined as Assistant Professor in Biophysics in the department of Physiology. I was fortunate to teach the first batches of both MBBS (2001-02) and B.Tech (1997-98) – for the latter an elective in the 8^th Semester on Neuro-fuzzy computing. I was also the first Coordinator of the Distance Education Directorate there.

From there I joined as the first faculty member (Assistant Professor) of the School of Medical Science and Technology (SMST) in IIT Kharagpur in August 2002. Then I joined the Amrita University, Coimbatore in July 2004 as Associate Professor and started two courses – M.Sc. (Medical Informatics) in 2005 (the first of its kind in India) and M.Tech (BME) in 2007. In 2008 I became the Founding Chair of Biomedical Informatics in PSG Institute of Medical Sciences and Research, Coimbatore. There I started offering online courses on Health Informatics and had more students from abroad than from India.

During 2011-12 I became a Visiting Professor in Health Informatics in Bangladesh, with the support of the Rockefeller Foundation, for starting a Masters Course in Health Informatics there.

From January 2013, I joined as the first Project Director of the Centre for Health Informatics, National Health Portal, under the Ministry of Health and Family Welfare, Government of India. Apart from developing the National Health Portal from scratch, I was also instrumental in coordinating the eHealth activities. I have been a member of the EHR Standards Committee since 2010. I was also the Chairperson for revising the Concept Note on the proposed National eHealth Authority of India. Consequently, the National Health Policy of 2017 clearly mentioned the setting up of the National Digital Health Authority to facilitate the adoption of Digital Health in India. On another note I have also been associated with the inclusion Software as a Medical Device in the Medical Devices Act of 2017. I have also been actively associated with the Bureau of Indian Standards for adopting and developing Standards for Health Informatics and Active Assisted Living. In other words, the “National” of my college is still inspiring me to undertake many activities of “National” importance.

In August 2017, I briefly returned to academics as Dean (Academics and Student Affairs) and Professor (Health Informatics) in the International Institute of Health Management Research, Delhi.

I have been appointed to the Board of Governors of the Washington Medical Science Institute, Saint Lucia, English Caribbean. I am also IMA Honorary Professor (2017-20) and Distinguished Fellow, HITLAB. I am a Fellow and Faculty of PSG-FAIMER Regional Institute, and have been Chair of HL7 India (2011-13), and, President of the Indian Association for Medical Informatics (IAMI – 2016). I’m a Founder Member of HL7 FHIR Foundation.

Now I am an independent consultant on Digital Health Standards and look forward to reinforcing the Digital Health Activities in India and elsewhere.