1

E- GOVERNANCE IN HEALTH

SECTOR

SWETHA ANN VARGHESE2nd YR MPH SCHOLAR

K.S HEGDE MEDICAL ACADEMY

2

OUTLINE OF MY PRESENTATION

Introduction Definition Pillars and models of e governance Evolution of e governance in world and India Functions and components Current scenario of e-governance Application E-health and telemedicine Phases of e-governance Health related issues and apps Strategy Areas of application Projects and programmes Implementation of e-governance Scope Challenges Emerging technologies Critique of e-governance in health care Advantages and disadvantages Conclusion

3

INTRODUCTIONE governance in health sector on broader

sense, the term not only deals with the technical development but also a new way of implementing an attitude and assurance for networked global thinking in order to improve the health care locally regionally worldwide by using information and communication technology.

4

DEFINITIONE- governance is an emerging field of health

informatics. It refers to the organization and delivery of health services and information using the internet and related technologies.

According to EU ICTs for Health:” e-Health describes the application of information and communications technologies across the whole range of functions that affect the health sector, from the doctor to the hospital manager, via nurses, data processing specialists, social security administrators and - of course – the patients.”

5

PILLARS OF E-GOVERNANCE

E governan

ce

People

Technology

Process

Resources

6

MODELSGovernment

to government

Government to

citizen

Government to

employees

7

EVOLUTION OF E-GOVERNANCE IN HEALTH SECTOR

The European Public Administration Network (EPAN):

1. Improved quality of information and information supply

2. Reduction of process time3. Reduction of administrative burdens4. Cost reduction5. Improved service level6. Increased efficiency7. Increased citizen customer satisfactionThe United States of America was especially

determined by the 1998 Government Paperwork Elimination Act introduced by former President Mr. Bill Clinton on December 17, 1999.

8

TOP 5 COUNTRIES IN WORLD OF USING E-GOVERNANCE

1

2

3

4

554

SwedenDenmark

NorwayUnited states

Netherlands

India

9

INDIA’S INITIATIVE IN E-GOVERNANCE

Mission 2007 : connected villages

through wireless services. E- Suvidha : It provide services like birth

certificate, Marriage Certificate & Information relating to Agriculture.

2010- NMCNP, SGPGIMS,MCTS

10

E-GOVERNANCE IN HEALTH SECTOR AND ITS COMPONENTS

Ministry of Health & Family Welfare (MoHFW) has undertaken various e-Health initiatives for improving the efficiency and effectiveness of healthcare system.

MoHFW undertook various activities or tasks during 2015 and its aim for implementing e-Health in an integrated manner across central and state levels in the health care service.

11

CONTINU….National Health Portal: it is launched on14th

November, 2014 single point access for authenticated health information for citizens, students, healthcare professionals and researchers (http://www.nhp.gov.in)

12

CONTINU…..NHP Voice Portal: Provides information

related to various issues of Health, Diseases, Lifestyle, First aid, Directory services, Health programme.

13

CONTINU….. Mobile Apps for NHP: Mobile Applications have been introduced to

access the National Health Portal through mobile phones it provides:

National Health Portal Directory Services,National AIDS Control Organisation (NACO) supported Blood Banks, Hospital Locator

14

CONTINU…Online Registration System:It was launched under Digital India programme. The ORS system provides an outline for linking various hospitals for Online Registration, Payment of fees and appointment, Online diagnostic reports, Enquiring availability of blood online.

15

CONTINU….National Identification Number (NIN) to

Health Facilities:This aims to assign an unique National

Identification Number (NIN) to each of the health facilities (both public & private) in order to facilitate inter-operability and information exchange.

National e-Health Authority (NeHA)Electronic Health Data Privacy & SecurityElectronic Health Record (HER)Integrated Health Information Platform (IHIP)

OTHERS:

16

FUNCTIONS OF E-GOVERNANCE

Simplifies the process Gather information Citizen participation Automation of services Revolutionizes government function Proper implementation Successful implementation

17

PHASES OF E-GOVERNANCE

Infrastructure

TransformationIntegration

18

CURRENT SCENARIO OF INDIA IN HEALTH SECTOR

Current e-Governance scenario in the healthcare sector in India is unsatisfactory.

Public health service run by Government is overburdened and collapsing.

It is due to large geographical size, increase population density, lack of transport, inaccessibility, illiteracy, poverty, poor nutritional status, diversity in food habit and life style are various impediments.

Medical science is a fast developing field which requires information resource .and urgent need for dissemination knowledge by interlinking primary, secondary and tertiary level health centres by ICT application.

19

APPLICATION OF ICT IN HEALTH CARE

ICT IN HEALTH CARE

TELEMEDICINE HIMS

CUSTOMER SERVICER/AWARENESS

USING INTENET/WEB PORTALS

MEDICAL TRANSCRIPTIO

N

20

E-HEALTH AND TELEMEDICINE INITIATIVES IN INDIA

Through the initiation of e-governance in health care; it started using automated information management tools like Electronic Medical Record (EMR), Electronic Health records, Computerized prescriptions.

Computerization of hospitals Quality Assurance (QA) by Total Quality Management (TQM), Medical and Nursing audits.

Computer is utilized for clinical decision making for selecting suitable tests, proper interpretation, and accuracy in diagnosis and update management for each treatment.

21

CONTINU…Hospital Information System (HIS):Majority of hospitals in country are

following manual process, which are difficult to access.

The insurance sector demands more efficient information storage and retrieval.

Automation alone can help hospitals to meet these challenges.

22

CONTINU…Tele-health Care Services: Telemedicine is an emerging Information

and Communication enabled health technology.

It has the potential to facilitate access to healthcare in underprivileged population if adopted into existing healthcare delivery system.

ISRO, DIT, MOCT

23

E-HOSPITAL Hospital Management System called e-

Hospital@NIC is solution specifically meant for the hospitals in Government Sector.

It helps the small to large size hospitals for streamline Patient care, Hospital administration, Ancillary services and Clinical support activities.

e-Hospital@NIC provides the benefits of Streamlined operations, Enhanced administration control, Improved response to patient care, Cost control and Improved productivity.

It reduces the patient waiting time for seeking health services.

24

HEALTH RELATED ISSUES AND APPS

“Health apps” are those that are intended for use in health and wellness of an individual but also in the field of medicine.

It can be used to prevent or mitigate diseases and their consequences (Prevention).

It enables for providing medical, care and other health related services.

It aims to provide support measures that aim at strengthening health (Health promotion). Applications that that mainly focusing on the detection, cure or alleviation of disease suffering and bodily harm are attributable to “medicine.”

25

CONTINU…. Health-related reference books, patient

diaries or fitness and wellness apps informational purposes- references teaching and learning materials and news apps.

Apps that provide support in health issues play a major role in particular in the context of chronic diseases.

Health apps are used for genuine diagnostic or therapeutic purposes, possibly touching on the area of medical devices are rare.

26

STRATEGY ON HEALTH APPS

Fair supply of health apps is the creation of an adequate infrastructure for the assurance of a good public digital and health literacy.

Financial incentive systems should not only be limited to certain technological approaches; the stronger focus should be placed on cross-application regulations.

27

AREAS OF APPLICATION OF HEALTH APPS

SL.NO

AREAS BENEFITS RISK

1. Prevention Change in lifestyleIncrease physical activityWeight controlChanging diet

Malfunctions

2. Diagnosis and treatment

Support diagnosis and treatmentRehabilitationCommunicationImproves provision of care

Misguided usage

3. Research oLarge sample sizeoConvenient dataoEasy for evaluateoIncluding more participants

Misinformation and Low network connectivity

28

VALUE OF E-GOVERANANCE IN HEALTH SERVICES

DATA

29

CONTINU…STRATEGIC RESOURCES SERVICES

ACCURATE AND RELEVANT BETTER DECISION MAKING

STORAGE EFFICIENT ALLOCATION OF RESOURCES

DURABLE TARGET HEALTH INTERVENTIONS

RETRIEVAL IDENTIFICATION PATIENT AND COMMUNITY NEEDS

DISTRIBUTED PREVENTIVE VHEALTH EDUCATION AND CHANGE IN HEALTH ORIENTED BEHAVIOUR

ANALYTICS EFFFECTIVE DISEASE MANAGEMENT

BETTER QUALITY CARE

30

E GOVERNANCE ENABLED PROJECTS IN HEALTH, WATER AND ENVIRONMENT

PROJECTS

IDSPMALARIA CONTROL

PROGRAMMEAIDS

STATE HEALTH SYSTEM PROJECTS

POLLUTION CONTROL BOARDS

ENVIRONMENT MANAGEMENT CAPACITY MANAGEMENT

31

CONTINU…..

Uttar Pradesh- WSRPRajasthan -WSRPMadhya Pradesh - WSRPMaharashtra- WSRP

32

1.INTEGRATED DISEASES SURVEILLANCE PROJECT

Integrated Disease Surveillance Project (IDSP) is a decentralized, State based Surveillance Program

To detect early warning signals of impending outbreaks.

To initiate an effective response. The project seeks to enhance analysis and

Disaster Preparedness, Mitigation and Response.

The National Institute of Communicable Diseases (NICD) serves as a hub of all the surveillance data activities and monitors all reports related to any disease outbreak.

33

2.NIKSHAY - PREVENTION & MONITORING OF

TUBERCULOSIS IN INDIA To monitor individual TB patient, NIKSHAY,

case-based, web-based application software has been developed an website. (http://nikshay.gov.in)

Monitoring and Management of users at national, state and district level.

Tuberculosis units register the TB patients and a unique number is generated for future reference.

Profiles of State TB Officers (STOs), District TB Officers (DTOs) and Tuberculosis Unit Officers and Officials.

Push & Pull based SMS technology.

34

CONTINU…

35

3.ONLINE MONITORING SYSTEM FOR THE TOTAL

SANITATION CAMPAIGN It is flagship program me It follows principle of low to no subsidy Nominal subsidy in the form of incentive is

given to rural poor households for construction of toilets.

Individual household latrines School Sanitation and Hygiene Education

(SSHE), Community Sanitary Complex

Anganwadi toilets supported by Rural Sanitary Marts (RSM) and Production Centres

(PCs). 607 projects have been sanctioned in 607

districts withtotal layout of 22672 crore.

36

4.NATIONAL VECTOR BORNE DISEASE CONTROL www.nvbdcp.gov.inThrough the e-governance in this program

me it includes 3 main activities: Interruption of transmission by reducing

population Early diagnosis and treatment Health education for community awareness

37

5. NATIONAL AIDS CONTROL PROGRAMME

Through the thematic media campaigns on TV and radio to cover issues of condom promotion ICTC/PPTCT, STI treatment and services.

Availability of ART services and blood safety

Tracking the patients according to treatment by the recorded data.

38

IMPLEMENTATION OF E-GOVERNANCE

Enhancing citizen awarenessUpgrading SkillsCommon StandardsTechnology evaluationExperience sharingSecurityReliable infrastructures

39

SCOPE FOR E-GOVERNANCE SERVICES

• Employment Services• Vehicle Registration• Driver’s License• Passport/Visa

• Agriculture • Land Record• Property Registration • Marriage Certificates• Taxes • Utility Services• Municipality Services

• Pensions• Insurance• Health Care • Death Certificate • Birth Certificate

• Health Care

• School Admission• Scholarships• e-Learning• Examination Results

40

CHALLENGES OF E-GOVERNANCE

Technical Challenges

Organizational Challenges

Economic Challenges

Interoperability Lack of interactive services

Cost

Privacy Lack of key persons

Maintainability

Security Population Reusability

Multiservice interaction

Different languages

Portability

41

CONTINU…FundingPolitical instabilityInefficient and Ineffective government process

42

LIMITATIONS OF E-GOVERNANCE

Budget. Poor IT literacy. Lack of electricity in rural areas. Corruption. Privacy problems.

43

CRITIQUE ON E-GOVERNANCE IN HEALTH SECTOR

Current Status of E-Governance in Hospitals:

The need for the study was in the context of massive investment made in ICT and healthcare.

168 respondents (including 63 healthcare professionals and 105 patients) were surveyed.

Questionnaire formed on the basis of the benchmarking of ICT index by the European Union (2004) was administered to the patients and the HCPs (Health Care Professionals).

Major finding: Lack of ICT awareness in the general public (most of

the people pay a personal visit to the hospitals for collection of reports).

It also indicates lack of training and awareness among the doctors about use of ICT.

44

E- GOVERNANCE THROUGH VARIOUS STATES

Wipro for Delhi Municipal Corporation (DMC):

It provides services for 6 hospitals Patient registration, Demographic details,

outpatient visits, doctors' appointment scheduling, Admission/ Discharge/ Transfer, Order Entry, Laboratory/ Radiology/ Cardiology Result Reporting, Operation Theatre Management and Pharmacy etc.

Handling large numbers of patients and helps them in providing better patient care.

An Electronic Patient Folder

45

CONTINU….TCS for Tamil Nadu: Tamil Nadu Government has allotted Rs

5 crore to Tata Consultancy Services (TCS) to develop a suitable solution to maintain Electronic Medical Records (EMR).

The system start functioning in all the 26 district headquarters hospitals, 162 Taluk hospitals and 77 Non-Taluka hospitals and some of the Primary Health Centres (PHCs) managed by the Government.

46

CONTINU…. Intel's World Ahead : The World Ahead Programme is an initiative

launched by Intel to provide education and healthcare service in India.

In the healthcare sector, Intel has carried out Tele-Health Projects in the places like Baramati, Maharashtra and Trivandrum, Tamil Nadu, and Child Health Monitoring in Chandni Chowk, Delhi.

Intel also provided a School Health Monitoring system, developed by Tata Consultancy Services.

47

CONTINU…. Karnataka mobile one- it was a mobile

governance platform for giving access to people for public services.

It was providing service access to over 4000citizen

Main aim was to address Issues in Rural areas, Health Education, Water Sanitation Maternal and Child problems

For registering and tracking the mother and child

Decision support with stakeholders Revolutionizing traditional service delivery

for rural areas.

48

EMERGING TECHNOLOGIES IN RURAL E-GOV

Sl.no Technology Services Health and Education care

1 GIS oResource useo Environmental management oallocation of resourcesoPeriodic assessmentoMonitor fundsoSocial audits

Mother and infant registrationPeriodic care trackingSpatial predictive modeling of any spread of epidemicsBiometric authentication of captured dataChoice of doctors

2 GPS Satellite imagery Mapping of areas for developmentOnline tracking system

49

NATIONAL E-GOVERNANCE A WAY FORWARD

It should made more effective in terms of outcome orientation and the advantage of the new and latest technology

Redefining the Strategy: Outcome Orientation

Process: Focus on Aadhaar Integration New and Innovative Technologies: Cloud

Computing, Mobile, and Localization Institutional Structure and Management People and Information: Capacity Bu i ld in

g a n d Empowering Stakeholders

50

CONTINU…..E-GOVERNANCE TO M-GOVERNANCE:Health, mobile health, is a term used for the

practice of medical and public health, supported by mobile devices.

e-Health can mean creating electronic versions of patient records across a national system while m-Health can serve as access points to provide remote information to healthcare providers.

Applications in the field of m-Health: Education and awareness:

Information about various subjects Testing and Treatment methods,

Availability of health services Disease management.

51

APPPS FOR HEALTH CARE PROFESSIONALS

Sl.no

Area Benefits

1 Information management Write notesDictate notesRecord audioTake photographsUse e-book reader

2 Time management Schedule appointmentsSchedule meetingsRecord case schedule

3 Health record maintenance and access

Access EHRsImages and scans

4 Communications Voice callingVideo calliingTexting E-mail

52

CONTINU…Area Benefits

5. Clinical decision making Decision support systemsTreatment guidelinesDiagnostic aidsLaboratory test orderingMedical exams

6. Patient monitoring Patient healthLocationRehabilitationCollect data

7. Medical education and Training

Continuing medical educationCase studiesSkill assessment tests

53

ADVANTAGES OF E GOVERNANCE

Improved efficiency, cost reduction and savings.

Time saving Better communication facilitation

between governments and citizens Online access of services Less bureaucracy and e-participation.

54

DISADVANTAGES OF E-GOVERNANCE

Lack of equality in public access to the internet

Lack of trust and cyber-crime Hyper- surveillance False sense of transparency Accountability

55

CONCLUSION Internet Technology has evolved rapidly in

the last few years there is a need to think strategically about where we want to be in the future. As time goes on, new technologies will continue to develop at a rapid pace and we must be flexible enough by showing quick response to the technology explosion.

56

REFERENCES https://www.researchgate.net/file.PostFil

eLoader.html?id....assetkey

Siteresources.worldbank.org?EXTIC4D/Resources/…./IC4D_2009_Chapters6.pdf

www98.griffith.edu.au/dspace/bitstream/handle/10072/…/67525_1.pdf

www.egovernment.uz/en/about_egov Arc.gov.in/11threp/

arc_11threport_ch7.pdf https://en.india.gov.in

57

CONTINU….. Verma. V. Current Status of E-Governance

in Hospitals. International Journal of Science and Research (IJSR), India Online ISSN:2319-7064.

From E- Governance to M-governance: The way Forward.Pandey.R. Sekhar V.K.S

E- Government: Its Role, Importance and Challenges. Ntulo.G, Otike. J. School of Information Sciences Moi University. Kenya

Chances and Risks of Mobile Health Apps- Abrigded Version.Albrecht.U-V, Hanovaer Medical School,2016.

58

CONTINU…. E-health in India: Opportunities and

Challenges. Kharade. J, Sharma. G Current e-Governance Scenario in

healthcare sector of India. Mahapatra. S.C et.al

Mobile Devices and Apps for Health Care Professionals: Use and Benefits. C. Lee Ventola, MS.

59

Thank youall