Medical Informatics in India: Looking Ahead

Intro- Medico who has stumbled into IT by chance, which

has now become a passion, now I am fulltime into
Healthcare IT.
Dream - to see the fruits of Healthcare reaching the utmost
reaches of India with the help of IT.

Various Descriptions of Med Informatics

o [Medical Informatics is] the field of information science

concerned with the analysis and dissemination of
medical data through the application of computers to
various aspects of health care and medicine.
National Library of Medicine

It would be pertinent to mention a few facts about the IT

and Healthcare scenario:
o We are in the midst of the third wave as Alvin Toffler
predicted. In fact as Fingar and Smith have predicted,
the time is ripe to prepare for a new, and potentially
even more radical, fourth wave of business
automation Human Interaction Management
Systems (HIMS).
o Very soon, there are going to be only two kinds of
people, IT literate and illiterates.

o As regards Healthcare:

o 80% of HC in India is with the pvt sec.

o More than 80% of HC seekers appch Pub Sec HC est
before going to pvt sec.
o 80% of exp incurred on exp and non-exp med stores.
o 80% of Reports and Returns are generated from the
ADT functions.
 o Patients spend 80-85% of their time in getting
investigations done or getting the inv results.
HC not a priority for policy makers at the Nat level (Health
does not figure anywhere in the National e-Governance
Plan 2006 (NeGP 2006), comprising of 27 Mission Mode
Projects (MMPs) and 10 components for e-governance)
7 Physicians per 10,000 Population
7 Hospital Beds per 10,000 Population
7.85 professional nurses per 10,000 population
Policy makers and vendors do not have adequate domain
knowledge of med care.
HC is mainly curative, prev care takes a backseat in India.
Doctors do not adapt well to IT due to the need to unlearn
well est ways of functioning and resistance to learning new
ways of working.
Healthcare providers spend 28-35% of their time
generating, collecting, collating, archiving, retrieving,
seeking and distributing information.

SO WHERE ARE WE??!!

I feel we are at the threshold of a revolution which is going

to impact every facet of healthcare. We must channelise
our efforts to make max utilization of IT for efficient and
effective delivery of healthcare and utilize it as a resource
multiplier.

How do we do it??
IMPLEMENTATION STRATEGY

In conformity with the National IT Plan, we have to plan

pragmatically for effective utilization of IT in all facets of
healthcare delivery both in urban and rural sectors.

STANDARDISE E-HEALTHCARE IN INDIA

o Initiate a National Consensus on developing

eHealthcare standards
o Will help in defining criteria for identifying quality
information, sharing and comparing findings.
o Will enable accreditation of E-enabled Healthcare
facilities

Pay heed to E-architecture: Architectural plans of all

healthcare establishments should incorporate
comprehensive plg for Networking instead of as an add-on
at a later stage.

IT enablement of healthcare est should be planned in a

deliberate and phased manner with due prioritization of
areas to be automated.

Exciting possibilities in a number of areas:

o Imaging
o Distance Medicine
o Medical Informatics / Bioinformatics
o Disaster / Emergency Medicare
o Healthcare Training and Instructional Systems
o Sensors and Robotics
o Communications infrastructure
 o Operating Room of the Future

Certain areas lend themselves easily to automation:

TRAINING
o Med/Nursing Colleges
Digital Classrooms
CBTs
Virtual Anatomy/Dissections
o CMEs/CNEs
Video-conferencing
o Paramedic trg
CBTs
o Trg of healthcare providers in the use of HMIS
applications in a NW environment
o Trg of healthcare seekers in the use of InterNet and e-
enabled services like TM kiosks, touch-screen
systems and Interactive Voice Response Systems to
seek info about the available HC services and to use
the same.
Identify areas where Automation gives max benefit: Some
of them are--
o Registration
UID
Photo ID Smart Cards
Smart Card readers
o Computerised ADT module
EMR/EHR
o Computerised Inventory Mgt in Med Stores
Bar-coding of medicines
o Diagnostic Services
Bar-coding of investigation requisitions and
results
RIS
o HL-7 & DICOM standards
o PACS
 o DR/CR systems
o Digital X-ray plates
LIS
Digital Microscopes
Bidirectional Autoanalysers
Clinical Decision Support Systems (CDSS)
o Computerised protocols
Investigations
Treatment
Disease related
o IHD
o Diabetes
o Hypertension
o Pregnancy
Speciality related
o Cardiology
o Oncology
o Nephrology
o Poison registry
o Disease Registries- Onco, Cardio,
Diabetes
o PDRs
o ICD codes
Mobile Computing-

o RFID technology

o Wi-Fi

o Healthcare on the move

o PDAs/Tablet PCs

Drug interactions

Dx codes
 treatment regimens

Viewing patient data

laboratory values

Accessory brain

Physicians in training

Patient Tracker

Pt alerts

Distant Medicine

Telemedicine
o Realtime

o Store and Fwd

Video Conf pt doc, doc doc

Txn of case records

Digital ECGs

X-rays/CT/MRI images

o ISRO initiative

VSAT

Hospital based TM NW
 VRCs

Mobile TM vans

Bandwidth issue

o MTNL & BSNL

ISDN/Leased lines

o Large amt of Dark Fiber av with Rail-tel, NTPC

Virtual Medicine

o Tele-Robotic Surgery

o Tele-Home Care

for

Elderly

Disabled

Chronically ill

Consisting of

Medicine reminders

Alerts

Health Councelling

o For ailments like

o Diabetes
 o IHD

o Cancers

By way of

Video Conferencing

SMS alerts

Data Entry - Bug bear of all HIS application

o Who

o How

o Physicians?

Voice recognition

Digital Slates/Pads - Pilot at AHRR, AFC, BHDC

o Other than physicians??

Med Transcription

Patient Information Systems

o Touch Screen Systems - AHRR

o IVRS- Pilot at AHRR

Combat Medical Support

o Battlefield Medical Information System-Telemedicine

(BMIST)

o Personal Information Carrier (PIC), Smart Cards

 o Fd Med Card (Trial being done for the Indian Army)
capable of digitization. For tracking and monitoring
the combat cas care at every echelon.

o Biometric sensors :Fighting Indian Soldier as a

System (FINSAS)

Disaster Medicine

o Emergency Med infrastructure equipped

Mobile TM vans

Vans with portable VSAT antennas

o Mobile phones

Rural Healthcare

o VRCs

o Mobile TM Vans

o TM NW enabled PHCs & CHCs

Preventive Health
o Health Edn of the pop

o Maint of databases pertaining to Immunisation/

Nutrition Pgmes

HOW TO DEVELOPE A RELIABLE MEDICAL INFORMATICS

NETWORK
Medical Informatics networks should include but not be limited
to the following applications:
* Network-wide, bedside access to a patient's medical history;
* Point-of-care data collection and retrieval;
* Clinical decision-support work stations;
* Electronic archiving of diagnostic images within the local
network and image transfer outside the local network;
* Pathology-specific practice and outcome protocols, with
physician alerts;
* Network-wide tracking of patients and resources used by those
patients; and
* Network-wide appointment and resource scheduling.

To ensure long-term reliability of medical informatics we

need to implement fully integrated network services that
can be upgraded cost-effectively.
o Be proactive in planning improvements. Anticipate
and evaluate future requirements for an integrated
network
o Combine freestanding departments and work groups.
Anticipate how to phase in any freestanding
departments and work groups e.g. Radiology, Lab,
Onco, Cardio etc.
o Devise a three-to-five-year plan to phase in upgrades.
Implement the network by investing in upgradable
equipment e.g. digital X-ray plates, DR & CR systems
compatible with industry standards such as those
endorsed by the American National Standards
 Institute (ANSI). Examples of areas in which such
standards have been implemented include digital
imaging communications (DICOM) technology, which
transmits graphics, and asynchronous transfer mode
(ATM) technology, which allows for the simultaneous
transmission of data, images, voice, and video.
o Engage experienced contractors who have
experience with medical and healthcare data systems
and who can combine disparate communications
requirements into a single, reliable, integrated
network.
o Maintain the network by minimizing potential for
downtime. Most downtime is caused by network
congestion, unclear applications, software glitches,
and operator errors. Quickly diagnosed by
computerized software linked to the network through
dedicated telephone lines, thus saving time and
assisting repair technicians before they arrive on site.
Remote diagnostics capabilities should be included
in network expansion plans.
o Train the network support staff. The general
contracting agreement should include ongoing
training for all members of the in-house network
support staff and access to a 24-hour, toll-free help
line.
o Hire knowledgeable network managers.

Lastly:-
Be prepared for initial hiccups
 Learn from the mistakes
Do not re-invent the wheel
Do not attempt too much, too soon.
Computers can never replace humans, it is the physician
only who will continue to treat the patients.