Benefits of signing up with NDHM for a Doctor

The National Digital Health Mission (NDHM) has been busy signing up doctors into the Digi-Doctor portal in 6 union territories and is being met with a mixed response. The Digi-Doctor Portal will act as a registry for the doctors and provide services to them and their patients. The services will be provided on the backbone of digital data portability initially related to patient demographic information and clinical data but later to expand to claims, prescriptions, and more. 

While voluntary, the government is urging doctors to sign-up. Before we do list the benefits of the NDHM framework for doctors it would be good to list the reasons the doctors may not want to sign-up as per a few snippets floating online. Three stand-out reasons put forth are:

• Doctors in general, will not be comfortable sharing their treatments and protocols with others, either for reasons of knowledge protection but more importantly due to opening themselves to malpractice suits.

• Some doctors who indulge in the same may feel their referral system under duress as NDHM ensures Diagnostic reporting is done a minimum number of times due to data being shared easily under consent.

• Lastly, there is some talk of having a standardized price list (already attempted under the Clinical Establishment Act) having to be shared as part of the NDHM sign-up, which may affect what the doctors charge for their services. While this standardization attempt is still speculation in terms of how it will be attempted or what it entails, this particular point will affect all doctors and hospitals irrespective of them being signed up or not and hence becomes moot.

Now to another important factor. All good doctors believe in the Hippocratic oath. It is seen so vividly in their fight against the COVID-19 waves, going out of their way to help their patients, sometimes at the cost of their own lives. Assuming that NDHM is securely and constructively implemented as envisioned, their belief in their oath should be enough of a reason to sign-up. Because simply put, having clear historical medical data of a patient and access to the latest reports helps them and the next doctor (when they contribute) make better decisions and hence helps their patient. That should be enough. 

But if it's not enough, here are a set of clear benefits for the doctors. Note: Many of these benefits are dependent on the doctors signing up, providing growth via a feedback loop for an even bigger benefit as the network size increases.

Some of the Administrative benefits are:

• License Renewal: What is promised a simplified license registration, license renewal, and NOC (No Objection Certificate) issuance when moving from one state to another now that there will be a single national registry as opposed to multiple councils and requirements they come with. With the process now online and digital with Digi-Doctor being integrated with various council systems, the pain many doctors feel today in renewing their license will be greatly reduced.
• A barrier for quacks: The registration process and then subsequent listing in the authorized registry will weed out the quacks that cause harm not only to patients but also to the reputation of doctors in general. These quacks also cause a decrease in revenue, as patients flock to these places which offer cheaper services. But only if doctors do register in numbers, can the registry be effective in weeding them out.
• CME Credit tracking: A new system will also be introduced to track CME (Continued medical education) credits effectively online to ensure Doctors are aware of where they stand and do not need to jump through hoops to get their credits counted.
• Faster Insurance approvals: Getting Insurance for the clinic or hospital owned by the doctor or the doctor’s malpractice indemnity will become much easier and faster once a doctor is verified in the authenticated registry. 

The Patient and Work-related benefits are:

• Access to Patient History: The main benefit of this whole exercise. Access to an accurate and complete history of the patient. As more doctors and organizations sign-up, a more complete picture of a patient’s medical history will form up. Access to this history will ensure better care for the patient through better decision making, lesser errors (e.g. medication adverse events) than what occurs today due to partial knowledge, and quicker response times due to having data readily available. Providing better continuity of care is a key benefit each doctor must consider.
• Tele-Consultations: Accessibility and authorizations to conduct teleconsultations plan to be brought under the ambit of NDHM. NDHM registered Doctors will be showcased on various government portals and registries as providers of teleconsultations. 
• Access to Global Standards: As a part of the digital framework Doctors will get access to various standards and protocols along with disease and drug registries.
• Access to Government Programs and Studies: Verified doctors will be considered for or apply for various government grants or be part of government health programs, research studies, etc. 

The Business-related benefits are:

• Online Presence: Greater discoverability of verified doctor profiles with their professional work history/journey instilling higher trust amongst patients on a national platform. They can share this profile link on social media or on other sites to increase their patient flow. Doctors will also be given recognition on the portal by the NHA based on various parameters, including the number of medical records contributed increasing their profile further.
• Access to Additional services: The NHA (National health authority) is planning to roll out additional services or allow 3rd party secure vendors to roll out services for doctors registered on the Digi-Doctor platform. Almost like a private marketplace for Doctors. 
• Storage of records: Using the Digi-doctor platform Doctor may get access to secured digital storage which can be used to store digital copies of their licenses, degree, and other critical credentials. Digitally verified versions of these documents will be considered legal to share.
• Patient insurance claims: The flow of payments between Insurance ←→ Hospital ←→ Doctor will speed up considerably, once we experience quicker claim turnaround times when the e-claim process is in place. This will reduce cash flow problems which several doctors do face from time to time due to delays in claim processing. 

There is apprehension amongst the Doctor community as there is with any Government registration process on whether it will infringe on their rights or bring in regulation that is detrimental to their wellbeing or livelihoods. 

The NHA for its part has started outreach programs at least in union territories so far to allay these fears. Their framework and plans so far speak of the good intentions of the ministry of health and family welfare (MOHFW). 

The question remains, will all these benefits outweigh the few niggling doubts in the minds of our current day superheroes.

References:

1. https://ndhm.gov.in/documents/ndhm_strategy_overview
2. https://tmc.gov.in/ncg/images/NDHM_presentation_for_NCG.pdf
3. https://www.medianama.com/wp-content/uploads/2021/04/draft_ndhm_implementation_strategy.pdf
4. https://ndhm.gov.in/home/digidoctor_faq

This article is authored by Aditya Patkar, CEO at Plus91

An overview of NDHM's Technology

National Health Authority (NHA) has been working on a new-age ecosystem for healthcare data for India, one which allows seamless availability and interoperability of Personal Health Records to authorized people, they started designing the new ecosystem network such that data is available always to the patient all the time. Further, patients can choose to share their data with their health care providers securely.

Since the implementation was envisioned to be in a mission mode, the initiative was named, and is currently referred to as the National Digital Health Mission (NDHM). 

NDHM Architecture

NDHM is employing a federated architecture for its ecosystem. That means that management and data access occurs in a federated manner where different entities or systems will manage the health data.
There is no central data storage controlling and storing data.

Using the Federated Health Records Framework (FHR), patients can access and view their health records, and provide consent to any HIPs and HIUs to access their data.

To ensure smooth consented data sharing and time-bound data access, it is necessary to make the data traceable and auditable. Therefore the FHR Framework architecture leverages MeitY's Data Empowerment and Protection Architecture (DEPA) electronic consent framework, which is already being used in the financial sector.

Here are some interesting technical features of the NDHM ecosystem

FHIR for all Medical Data

One of the prevalent problems in the healthcare software landscape is that software providers have their own proprietary data structures and way of dealing with medical data. Despite having various standards available in the industry, very few providers use them correctly. This affects interoperability between systems. That is why it was required that all the systems on the ecosystem use the same standards for medical data so that data is interoperable. This is why the FHIR(Fast Healthcare Interoperability Resources) Specification was chosen as the data exchange format.

Asynchronous APIs

All the APIs(Application Programming Interfaces) of NDHM are asynchronous APIs. That means that you do not get the response of your requests synchronously but the response is sent back to your endpoints as a callback once your request is processed. This is a pretty standard technique in large distributed systems, and its use is expected and welcomed.  As things start moving forwards, more providers will join and the number of transactions will grow exponentially. This model allows them to scale the network easily as we move forward.

It is also important to know that plenty of interactions happen between Health Information providers (HIPs) and each HIP software may handle requests differently. So making the API calls asynchronous, helps manage the variable serving capabilities of different HIP software graciously.

Patient Privacy & Security Features of NDHM

Privacy of the Patient Data is crucial and a lot of people are not comfortable with sharing their personal health data on central servers, especially sharing them with the government without their consent. The model that was adapted for this handles this concern very well. 

Let's see how this is handled to ensure patient privacy is ensured,  and it's the patient who owns the data.

HIPs can only create data if authorized by the Patient:

HIPs cannot create any data against a Health ID without first being authorized by the Patient. HIP obtains an Auth Code from NDHM Gateway by one of the following authorization methods:

• Demographics Verification - Patient Demographics data supplied by HIP matches the Demographics data registered with the Health ID
• Mobile OTP - Patient shares OTP sent to registered mobile number with the given health ID
• Aadhar OTP - Patients shares OTP sent to the mobile number registered to Aadhar No associated with the given health ID
• QR Code Share - Patient has the option to share their health ID by scanning the QR code available to the registration desk and the given HIP receives Patient Information and the Auth Code.

This ensures that no health data against a patient Health ID is being created without the patient’s approval.

An HIU(Health Information User) can only get past health records of other HIPs if consented by Patient

Other HIU's do not get a Patient’s past health records generated by other HIPs without the patient’s consent. If an HIU wishes to receive the past records, HIU needs to generate a Consent request with the following information:

• Types of Health Data (OPConsultation, Prescriptions, Diagnostics Records, Discharge Summary & Immunization)
• The purpose for Requesting Data
• The date range of the data required
• Consent Expiry - On consent expiry, this health data get destroyed from HIU’s system

As soon as this request is generated, the patient is notified about this consent request and he can review the request in the PHR app. The patient will be able to see all the data requested by HIU as mentioned above. Not only can the patient review the data but the patient also has the option to modify the request data( e.g. change consent expiry or type of data he/she wish to share or even change the date range of health records requested). This data is only shared with the HIU if the patient approves the consent request. If he denies the request, HIU does not receive this data.

Not only can patients review these things, but the patient can also decide to prematurely revoke access to any HIU‘s approved requests. If a patient decides to revoke access, the corresponding data will get destroyed from HIU’s system.

This mechanism ensures that patients always have control over their data.

Peer to Peer Data Transfer Between HIP & HIU

As mentioned earlier, a lot of patients are uncomfortable about their private health records being available to and accessed by the government. To avoid this altogether, NDHM never handles the data themselves. The NDHM Gateway only coordinates the connections between HIP and HIU. The actual data transfers happen between HIP & HIU directly and it is effected using a peer-to-peer connection. It does not pass through NDHM, and so there is no way NDHM can access the data.

Data exchange between the HIP & the HIU also happens using encrypted medical records above the standard TLS connection. This adds an additional layer of encryption for medical data.

The ECDH (Elliptic-curve Diffie–Hellman) key agreement protocol is used for this. The HIP & the HIU generate their own pair of public-private keys using curve25519 elliptic curve. This curve provides 128 bits of security for the data being encrypted.

The HIP will use its own private key and the HIU’s public key to compute a session key and encrypt the content using an AES GCM cipher. The HIU can use their private key and the HIP’s public key and compute the session key to decrypt the data. So even if the encrypted data is leaked, no one except these two parties can encrypt/decrypt the data.

Final Thoughts

The NDHM is a wonderful initiative by the government to streamline the healthcare landscape in India today. At this time, all the health data is available as silos within different solutions and systems. It is very difficult, if not impossible, to make the data interoperable between systems. Consequently, it is difficult for patients to access the data across these silos and manage it properly within a system of theirs choice. This project has the ability to revolutionize the industry. This could be the UPI of Healthcare.

It is one thing to have a concept and another thing to implement and execute it. So far NDHM seems to be going in the right direction.  And there is hope that it will continue to do so. 

Technology is being given equal importance to gain the trust of all players involved in this industry.

Privacy and Security have been a prime priority in the project as you can see from the above article, this is an oft-ignored aspect in old projects. Hope it continues to stay this way.

References

https://sandbox.ndhm.gov.in/docs/architecture

https://sandbox.ndhm.gov.in/docs/data_encrypt_decrypt


This blog post has been co-authored by Kishan Gor , Aditya Patkar and Nrip Nihalani

MEDICAL WEBSITES CAN HELP A PATIENT EXPERIENCE A DOCTOR'S AWESOMENESS

How IT can facilitate Information Therapy?

The end customer in the business of Medicine needs information. Everyday technology adds new ways in which we store and share this information for many to use, reuse, improve and share some more.

In this day and age of the Internet, Mobile Phones and Social Media; Patients are empowered with the possibility of Real Time Communication, 24/7 Access to Information and Live Community Feedback. 

Today’s patients have been exposed to numerous possibilities besides the ones which our forefathers would know of. This exposure has empowered this generation of patients to ask for better care, better facilities, cheaper alternatives, and more useful ways of using technology to provide healthcare as well as healthcare information. However, in spite of large amounts of information available today, a big problem that exists today is that the information is not necessarily usable when it is most needed.

To effectively facilitate Information Therapy, Information Technology must bring about a marriage of ideas with utility; IT has to ensure all actors in this ecosystem come together to improve information management for the benefit of the patient, the staff and decision-makers throughout the healthcare sector.  Only then can Information Therapy  be provided to various participants of the health care ecosystem through the different stages of an illness:

• Diagnosis and information gathering
• Finding a Provider
• Soliciting Second Opinion
• Accepting a diagnosis
• Participation in research
• Being an champion or advocate

For Technology to be successful at this there should be sustained focus on different avenues of Information Therapy.

We explore 5 avenues with roadmaps below:

Avenue 1: Medical Information Sources

IT vendors must work at creating Healthcare and Medical Information Knowledge Bases. This can be about medicines, diagnostics, decision trees, side effects, precautions, etc.

Technology should evolve to allow for more effective ways for Updating Information in such Knowledge Bases. These could be based on curation, criticism, collaboration to ensure that it is self adjusting, effective and patient-centered.

Advancements in Social Technology will provide new ways for spreading this information.
 

Innovation in Delivery mechanisms will provide easier ways for others to consume this information

This will help

-- Create Informed Patients

-- Create Valued Sources

-- Ensure poor sources are filtered and rejected

Avenue 2: Digital Identities for Providers and Provider Information Sources

The logical first step to creating rich Databanks of Provider Information is to create identities for Providers in the electronic world. The simplest way to do this is to Create Websites for Doctors, Clinics and Hospitals. This may not necessarily be individual websites for practices which don’t want to invest in one, but even simpler informative single web pages to fulfill the purpose of creating an identity for them.
 

Such websites can be optimized to convey Services, Location and Contact Information, Medical Notes, Special Cases treated. Such optimization will help in disseminating useful provider information to people looking for the same. This isn’t advertising, it’s a service: people today face many choices and are hampered by lack of information, improving their ability to find information quickly is beneficial to them.

For those practices and Practioneers who decide to engage IT to create digital identities (web sites), the following guidelines must be provided:

-- On your website, don’t only talk about you, tell the patients more about what diseases and disabilities you treat, what are the latest treatments, generic advice and maybe even help them going to right person if you weren’t involved.

-- Use tools like interactive patient forms which can be filled before the patient arrives at the center

-- Use query forms on the website so that patients can ask you about their problems and doubts; this gives the feeling to your patients that you are available to them 24/7 without actually being there

As was the case with Medical Information Sources, Advancements in Social Technology will provide new ways for sharing Provider Information.

Technology Vendors must provide easier ways for Provider information to be located and searched and which is available of different types of media.

-- Create Directories of Providers based on Provider Information

-- The Directories allow for Feedback on providers in a controlled environment

Avenue 3: Patient Provider Communication

True engagement comes about through two-way, mutually beneficial 
conversations.

Technology must look to create multiple ways to facilitate both formal and informal Patient- Provider Communication. The telephone made a huge impact on the way we communicate, and so did email. Newer technologies must be used to offer ease of use, larger acceptance and lower costs. Many providers today communicate with their patients using skype, google chat and even facebook. Technologies must build on such success stories.

Provider –Patient Communication will also benefit if vendors Link Communication mechanisms to Provider Information Sources and Health Information Exchanges

-- Provide integrations of these mechanisms with clinical and diagnostic software (EMR's, EHR's , etc)

-- Emailing of schedules and reports to patients is a must.

-- Using SMS to send Medical alerts, reminders, and schedules

-- Go the extra distance and use Social Media to provide alerts and reminders to patients via Facebook Messages, Twitter DM's, etc.

Avenue 4:  Health Information Exchanges

 
Technology Vendors must work together to create Health Information Exchanges(HIE’s) based on interlinking of Electronic Medical Records, Electronic Health Records, Laboratory Data and Patient Health Records across Providers and Patients.

They help by providing Patients with the option to switch providers easily, allowing doctors to easily refer patients to other doctors for multiple opinions, providing direct access to laboratory data for physicians along with a number of potential benefits which are expected in the future due to the creation of a huge data bank of Medical Data including Symptoms, Diagnostics and Prescriptions.

HIE’s must be designed with Programming Interfaces and sufficient freedom to allow Technology Enthusiasts and Innovators to be able to create novel ways of using and sharing the vast volume of data within HIE’s as long as patient and provider confidentiality is not compromised.

Avenue 5:  Online Health Communities

For years, patients have liked to work in groups, to support each other, to help themselves cope with illnesses which their near and dear ones don’t understand, to seek advice from others who have similar ailments. Bringing people together in collaborative dialogue to explore social conditions that are the major influences of health and illness generates deeper collective awareness and community-driven action.

Since Individuals don’t see their lives partitioned into an online and offline world, Online communities should be given as much value as offline ones. A variety of Online Communities must come up for connecting patients quickly and privately with others who share similar health experiences.

Technology today exists not only in the form of created online communities but also online community frameworks which allow just about anyone with an idea of a community to set up an online one, full with video and audio chats, whiteboarding, discussion forums and groups and all the other good stuff.

This allows the creation for integrated digital ecosystem which simultaneously addresses both individual and social dimensions of health.

-- Allow Patients to engage with each other

-- Allow Providers to engage with this medium

 Case Studies showcasing IT providing effective Information Therapy using the avenues discussed above:

 - A Hospital Website provides emergency response numbers which earlier would only be found in a book. Today the website acts like an instant phone book for someone looking for these numbers during an emergency. Hence the Website becomes a good medium to share information about the medical entity for someone to access on the go. Taking emergency medicine up a notch by providing real time information through e-health channels

 - A Gynaecologist’s website allows a patient to calculate her schedule for check-ups and ultrasound visits and set reminders for the same. Whereas earlier, she would have to get it written down by the Doctor, and sure enough in all that stress call the Doctor each time to confirm, how all she needs to go is go on her trusted Doctor’s website and check the dates herself. E-Health, helping people plan their healthcare long term through tools that promote and help understand what they need to do

 - A Cancer patient after each chemo session feels low and unhappy, and is tired of the emotional stress involved. Being a shy person, he never talks to anyone and shies away from contact. Now online, he has a new lease of life, being able to interact and get support from patients just like him. Moreover he can do this anonymously learning how to cope with the pressure and the pain. Learning simple remedies and tried tricks from people who know and feel what he is going through. The power of e-health through patient forums, support groups and medical help portals online, allowing information flow where there was none physically

 - A patient in a remote village in South India suffering from acute pain in the abdomen has to make do with the local village doctor’s prescription.  A year later, a telemedicine pilot allows this same patient to get a second opinion using a remote video link and also by sharing X-rays of the abdomen using this equipment.  He also is able to identify what’s happening to him via the printouts he gets from the telemedicine center and realizes that he must work at improving his diet.

This is the 6th and final Article in a series of Articles on Using IT to facilitate Information Therapy by Nrip Nihalani and Aditya Patkar . These articles form the basis of the chapter "IT for IT" by the authors which they contributed to the book "Using Information Therapy to Put Patients First"

Plus91 Technologies Pvt. Ltd.

http://www.plus91.in

http://www.plus91online.com

http://www.twitter.com/plus91

Digital Identities for Providers and Provider Information Sources : Using IT to facilitate Information Therapy

The logical first step to creating rich Databanks of Provider Information is to create identities for Providers in the electronic world. The simplest way to do this is to Create Websites for Doctors, Clinics and Hospitals. This may not necessarily be individual websites for practices which don’t want to invest in one, but can even be simple informative single web pages to fulfill the purpose of creating an identity for them aka http://www.about.me

Such websites can be optimized to convey Services, Location and Contact Information, Medical Notes, Special Cases treated. Such optimization will help in disseminating useful provider information to people looking for the same. This isn’t advertising, it’s a service: people today face many choices and are hampered by lack of information, improving their ability to find information quickly is beneficial to them. 

For those Practices and Practioneers who decide to engage IT to create digital identities (web sites), the following guidelines must be provided: 

-- On your website, don’t only talk about you, tell the patients more about what diseases and disabilities you treat, what are the latest treatments, generic advice and maybe even help them going to right person if you weren’t involved. 

-- Use tools like interactive patient forms which can be filled before the patient arrives at the center

-- Use query forms on the website so that patients can ask you about their problems and doubts; this gives the feeling to your patients that you are available to them 24/7 without actually being there 

As was the case with Medical Information Sources, Advancements in Social Technology will provide new ways for sharing Provider Information. 

Technology Vendors must provide easier ways for Provider information to be located and searched and which is available of different types of media.

-- Create Directories of Providers based on Provider Information

-- The Directories allow for Feedback on providers in a controlled environment

This is the 3rd Article in a series of Articles on Using IT to facilitate Information Therapy by Nrip Nihalani and Aditya Patkar

Using IT to facilitate Information Therapy : Medical Information Sources

To effectively facilitate Information Therapy, Information Technology must bring about a marriage of ideas with utility; IT has to ensure all actors in the medical ecosystem come together to improve information management for the benefit of the patient, the staff and decision-makers throughout the healthcare sector.

Medical Information Sources

IT vendors must work at creating Healthcare and Medical Information Knowledge Bases. These can be about medicines, diagnostics, decision trees, side effects, precautions, treatment data and more.

Technology should evolve to allow for more effective ways for Updating Information in such Knowledge Bases. These could be based on curation, criticism, collaboration to ensure that it is self adjusting, effective and patient-centered.

Advancements in Social Technology will provide new ways for spreading this information.

Innovation in Delivery mechanisms will provide easier ways for others to consume this information

This will help

-- Create Informed Patients

-- Create Valued Sources

-- Ensure poor sources are filtered and rejected

In the next article we'll look at How Establishing Digital Identities for Providers(Doctors/Clinics) and Provider Information Sources will enhance the spread of Information Therapy

 

 This is the 2nd Article in a series of Articles on Using IT to facilitate Information Therapy by Nrip Nihalani and Aditya Patkar

Plus91 Technologies Pvt. Ltd.

http://www.plus91.in

http://www.plus91online.com

http://www.twitter.com/plus91

Learnings from Japan: National Health IT Networks are required

The past few days have involved almost all of us praying for Japan which was ravaged by a severe earthquake and tsunami. Japan's most powerful earthquake in 140 years struck the north-east coast on March 11^th 2011, triggering a massive tsunami leaving behind many homeless and stranded. (Information and Situation Report from WHO)

As we continue praying for hope in Japan, we are also learning all we can about how disasters can impact the way we live and seek to improve. Sadly, Japan now faces severe logistical problems and with the latest news on the mishap at a nuclear reactor, the situation only seems to be getting worse. While Japanese officials have more pressing issues on their hands, a problem that will arise as time progresses will be that those left alive may find themselves without their medical records. Natural disasters wipe out everything — including paper medical records as well as computer and communication networks.

In this time of national crisis, it would have certainly been helpful for Japan to have a robust Healthcare IT network in place. A collaborative one where it is easy to share data, which is securely backed up redundantly in multiple locations that would leverage geographical diversity as a means of countering nature’s unpredictability: Geographical Division Multiplexing if you please;

While Japan does have a Healthcare IT strategy setup, with benefits and stimulus funds, it is relatively new and yet to mature. Health data digitization and Electronic Record Keeping is still in its infancy. Japan does not boast of large scale Electronic Medical Record coverage.

Wouldn’t any country ride out disasters better with health data sharing in place? This should be taken as a wakeup call as well as a learning lesson by all nations which haven’t yet devoted time and money to setting up Nationwide Health IT Infrastructures.

India for one must be looking at learning from this.  Having a Nationwide Health IT Strategy should be treated as important as a Tsunami Alerting System (TAS).  Purists will argue that a Nationwide Health IT System is not intended for alerting and helping contain situations like the TAS. And they are not completely wrong. 

In many cases it has been observed that long term benefits are eventually forgotten. Instead, this concept of “Long Term benefits” must be replaced with Pre-planned Goals which must be “Sought” on maturity of a model.  Now, any system can provide a set of benefits directly on implementation, and an additional set when it has matured.

Similarly, the use case of using a Nationwide Health IT System for predicting and alerting requires a certain amount of usage at first.  A sophisticated and mature Nationwide Healthcare Network built using technology can identify the emergence of possible pandemics. Trends in symptoms can help identify risk areas, and collaborative diagnosis can help is sharing treatment plans and improving them.

One must understand that if maturity of a network is required for additional goals and since that takes time, one must seek to implement early. 

Links of Interest

WHO Page on Environmental Health in Emergencies

WHO page on Myths and Realities in Disaster Situations

What do Doctors love doing on the Internet?

Thanks Doctor for visiting. We are conducting a  survey under the prerogative of  Indian Health Journal. We would love to hear about how you spend your time on the Internet.

Click here to take this survey
 
Hoping to make the online experience for Doctors an enriching experience.

The results will be part of a publication and will be available freely. To know more about Indian Health Journal , Please email indianhealthjournal@plus91.in

Thank you from all of us at Plus91

Technoclinics- Upcoming scenario in India

Medical industry in India is proud to have adopted the latest medical equipments in every specialization and has achieved tremendous results in terms of rapid and effective treatment. The benefits that the Indian IT sector has made in the global village the past 15 years, are now being extended to the Indian Healthcare industry too! 

Taking advantage of these  some clinics are transforming into “technoclinics” by smartly using technology and software in their practice. Dr. Ankit Khanna (MDS) at Pune, who uses a Blackberry to track his online appointments says, “Advances in technology have definitely changed today’s scenario in the dental practice. Earlier for root canal treatments, X-rays taken were on a thin film which gave information only about pathology and cavity. But with the Digital X-ray, it is now possible to know the bone density, height, thickness along with the conventional pathological details and cavity of the teeth.”

Moreover, the paper-based records are now shaping into Electronic Medical Records storing all the patient details along with the medical history and previous visits. Searching a patient record barely takes seconds and all the information is available at fingertips. Dr. Khanna cites out the benefits of EMR, “With EMR, the medical records are a proof which reduces the conflicts between doctor and patient. If a patient visits two dentists for treatment, with the software now it is easy to show the patient which treatment he came for to avoid the confusion.” Dr. Khanna confides in software stating that he can now provide warranty with the treatment as he successfully manages and tracks the patient records strengthening the patient-doctor relationship.

Most of the clinics are still maintaining the paper based records which eventually lead to frustration and chaos. There are some clinics where the doctors prescribe medicines on a follow up visit memorising the patient history which proves dangerous for the patient as well as the doctor! Imagine how much better it would be if the doctor knew the patient history and accordingly prescribed the medicines? That’s where the software plays the role and reduces the risks of memory-based treatment.

The doctors of “technoclinics” are enjoying their practice because they only have to concentrate on proper diagnosis and treatment whereas the entire clinic administration is managed by the software. Within the coming years, its predicted that the majority of clinics will resort to software, thus improving their practice,  benefit in terms of hassle-free practice, improved profits, time and money savings and also building stronger patient relationships. This revolution is what awaits the healthcare sector in India.

by Pooja Raval and Nrip Nihalani

Patient Safety

Few Sundays ago we were privileged enough to be invited by Dr. Nikhil Datar, a pre-eminent gynecologist and medico-legal expert to witness his premier talk on Patient Safety. It was hosted by IMA Dombivali and had a strong audience of over 40 doctors waiting to hear Dr. Datar’s talk. Dr. Datar had recently returned from UK where he attended a program organized by WHO on Patient Safety. Plus91 Technologies believes in making patient centric solutions which don’t just automate the clinic or hospital but also improve quality and service. Keeping this in mind, the presentation was interesting not just for the doctors but also for us.

The doctors were interested in the talk, intrigued by what new information can they hear. It started slowly but filled with practical examples the doctors soon were eager to know more. More than that they realized in their own practice they need to reflect and close loopholes so that they ensure patient safety. The doctors really got involved with questions, interactive cases and videos. We think they all walked out little bit wiser. As a software company involved in Healthcare, we think patient safety becomes a vital cog in what we are doing and it works at multiple levels. 1. Creating solutions which ensure and promote safety, 2. using the patient safety angle to promote such solutions which benefit the doctor in many more ways, but they finally see it as useful when something hard hitting as this is spoken about and 3. Increasing patient interaction and service allowing patients to feel safer and learn on how they should protect themselves too.

So what all does patient safety entail? It covers a lot of ground from something simple like washing your hands before a physical examination to something complicated as giving instructions during a high pressure surgery. They key learning was awareness that things can go wrong and improving communications and processes to prevent minor errors from becoming major issues. Simple techniques like reading medicine names allowed, using color coding on various instruments, storing patient records in a neat and systematic manner help provide better quality care to the patient. We think from hearing his talk, the biggest initiative one can take in improving patient safety is increasing ones awareness in their surroundings. Being aware of the possibility and the effects of your actions goes a long way in preventing mishaps that can happen. Some major inferences were: Out of the 3.7% cases, only 1% could be called as negligent, 50% of these are preventable and most notable – majority of them were not individual failures but the system failures.

We think a lot of good work is now being done in this field by numerous players. The ones which Plus91 Technologies is directly involved with include Dr. Nikhil Datar an epxert in the field, PIET (Patient Information and Education Trust) and NGO, PEAS (Patient Education and Awareness Series) who make wonderful videos and content driven education material, HELP (Healthcare Education Library for People) which have seminars weekly apart from the actual library initiative and Dr. Malpani who is organizing a conference in October in Mumbai exclusively dealing with Patient Safety. As technology pervades healthcare, we can already envision so many places where Plus91 can actively help improve patient safety standards. The possibilities are exciting not only in their scope and challenge but also because this is probably one place we can actually be able to claim we saved a life and that thought gives us a tremendous boost.

Improved Patient Safety Using Software

Patient Safety is a vital aspect of healthcare. With a fairly large number of indirect deaths and also potentially life threatening situations resulting directly from lack patient safety it becomes a vital cog in the healthcare machinery. Software products are introduced in any setup to increase efficiency and accuracy, both important factors when trying to improve safety. I am going to highlight some basic examples how inherently as well by actual design patient safety measures can be improved through normal Electronic Medical Records or Practice Management Software.

1. Prescriptions and Medications: The most common errors are seen when doctors write prescriptions on paper and the patient or the chemist misread the prescription. This is a common occurrence and a printed prescription generated from software with already present Drug Data is the safest bet against such a mishap. Other errors which can be prevented include, mistakes made by doctors in writing the dosage or strength, which in software can be fixed to prevent wrong entries, also a check on concomitant medications interfering the drug can be done. These features are already present in the Plus91 clinic package Clinkare. Ensures no errors happen due to differing writing styles or hand writing.
Another neat feature is sending reminders to the patients/nurses to take the appropriate medication at the correct time via SMS. This ensures no missed dosage which could have lead to problems. This feature is available in ClinION the hospital management solution from Plus91 Technologies.

2. Patient History: Doctors in a hurry, if patient comes without papers can prescribe the wrong treatment in case the data is not properly documented. It is vital to know previous visit experiences which can help the doctor make a better decision. Almost all softwares allow storing overall patient and current complaint history which helps doctors make better and more accurate decisions thus ensuring patient safety. This feature ensures that reliance on memory is less!
In the new age software patient history can also be coupled with Clinical Decision Support systems to help the doctor make his or her decisions in a better and more accurate manner.

3. Patient Data Entry: This is an exclusively software based point. Accurate entry in the system can be ensured by various validation measures and checks. This may slow down the process but a good process ensures the software protects the basic problems that can happen. Some key examples are: a. Validated fields which take only certain values and anything outside throws an error, b. Every time a new page is opened or traversed the patient name is popped up to double check the correct patient data is being filled in, c. Two person check entries at very vital and critical data entry points (used often in clinical trial data management), d. SMS or Email alerts in case of a vital sign going outside normal range at the ICU

4. Consent Checks: A patient must know what procedure they are undergoing, the risks and also most importantly dos and don’ts. A software can for all the procedures ensure that the consents are filled using a reminder / validation system to ensure the patients have been given the once over either by the doctor as a series of questions and answers which are entered in the system or using a video/presentation format with a consent thumbprint or electronic signature taken at the end. This is vital so that the patient does not make mistakes because of not knowing he or she had to come empty stomach for a procedure.
Plus91 softwares automatically allow you to link vital consent forms to various tests, procedures and consultations and remind you to get them filled.

5. Check lists: The Indian Born adviser to the American President on Healthcare issues is Dr. Gawande just released his new book “The Checklist Manifesto”. A checklist is the doctor and hospital staffs most trusted friend. Often negligence cases leading to patient safety mishaps happen because proper procedure was not followed. Many types of software come with check lists which need to be marked as complete before the next screen of tasks can be accessed. This ensures that all important steps are carried out and in order.
Checklists can be determinate that is fixed in nature like an inventory for a particular type of surgery. Some check lists can be flexible, like an in house patient prescription check list or schedule followed for an entire ward. Using software both can be checked and managed without a fuss.

6. Improved analysis: Software allow us to collate all sorts of medical data, this data can now also be analyzed to make future decisions better. Knowing what kind of patients react to which medication, or which months cause more complaints of a particular type of disease or maybe information on which doctors have better recuperation rates vis-à-vis their treatment methods all allow the healthcare system to better prepared for future patients.