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

Today is the Universal Health Coverage (UHC) day.

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.

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

Source: www.ehealth-impact.org

§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)

Source: http://www.who.int/bulletin/volumes/90/5/11-099069/en/  

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.