Role of Digital health in public health care

1. Digital Health
Role of DIGITAL HEALTH in
Public health sector
By- Dr Nilanjan Roy
JR-2, CFM
AIIMS

2. 1. Introduction
2. Digital Healthcare Applications
a. Tele-medicne
b. EHR
c. mHealth
d. IoMT
3. Benefits of Digital Health
4. Challenges of Digital Health
5. Digital Health in COVID-19
6. NDHM
a. NDHM Journey
b. NDHM a Game changer
c. Services provided by NDHM
7. OnGoing Initiatives on Digital Health in India
8. Future of Digital Health
CONTENTS:
2
15
5-14
16
17
28
21-27
18-20
SLIDE No.
3-4

3. Key Figures in Digital Healthcare

4. 4

5. The Milestone of Digital Health
continues
Beginning
1897
First medical diagnosis
over telephone
International Medical
informatics
association
European health
telematics association
Development of
digital therapeutics
FITBIT
FDA “digital health
center of Excellence”.
American telematics
association
1989 1999 2007
1897 2005 2017
5

6. What is Digital Health?
The use of information and communications technologies in medicine and other health
professions to manage illnesses and health risks and to promote wellness.
Digital Health is envisioned to:
6
● Improve access to healthcare
● Reduce any inefficiencies in the healthcare system
● Improve the quality of care
● Lower the cost of healthcare
● Provide more personalized health care.

7. Modern Digital Healthcare Applications
2. Electronic Health Record
1. Telemedicine
3. mHealth 4. Internet of Medical Things
7

8. Telehealth
The delivery and facilitation of health
and health-related services via
telecommunications and digital
communication technologies., which
includes:
● medical care
● patient education,
● health information services
● self-care
8
TELE-HEALTH
TELE-MEDICINE
Interchangeably
1. Telemedicine & Telehealth
Telemedicine
Oxford’s telemedicine definition is “the
remote diagnosis and treatment of
patients by means of telecommunications
technology.”

9. 9
The Confusing Acronyms
Electronic
Medical
records
(EMR)
Electronic
Health
Record
(EHR)
Computer
Based
Patient
Record
(CPRs)
Health
Information
System
(HIS)
Electronic
Patient
records
(EPRs)
Personal
Health
Record
(PHRs)
2. EHR- electronic health record
Systematized collection & storage of health information of person/population in digital
format.These records can be shared across different health care settings

10. Medical Records- Documentation of patients history, examination, investigations and
treatment
Use:
1. Continuty of providing care
2. Patient safety
3. Communication between providers
4. Medico-legal purpose
5. Claims and reimbursements.
6. Patient Use
7. Clinical researches
10
EHR- electronic health record

11. EHR- electronic health record
An individual's official health document that is shared among multiple facilities and agencies.
EHR should include:
● Patient’s demographic
● Physician notes
● Computerized medication order entry
● Computerized Lab order entry & Lab results
● Problem list
11
● Medication list
● Discharge summary
● Diagnostic test results
● Radiological reports

12. 12
Electronic Health Records (EHR) & electronic Medical Records (EMR)
0 years
Miss x Born
8 years
09/11/1948
Diarrhoea
29 years
Car accident on
07/11/1969
Femur fracture
56 years
Of Breast Ca
Remession
5 years
01/01/1940 -
03/12/1944
Immunization
24 years
A male child
Delivered a Baby
50 years
Diagnosed with breast Ca
70 years
11/11/2010
Died of pneumonia
08/12/1943
Viral infection
19/03/1955
UTI
19/03/1980
Depression
29/02/1992-
24/11/992
Chemotherapy
EMR EHR

13. Benefits of EHR:
● Ubiquitous availability (anytime, anywhere, everyone is authorized )
● Multiple concurrent users
● The end of “Where the heck is the patients’s record?!”
● Ability to control & enforce access security
● Structured Data entry possible
● Data presentation that is easier to understand (eg graphs)
● Process improvement in patient care
● No Doctor’s Handwriting, No confusion!!!!
13

14. 3. mHealth
Applications:
a. Preventive healthcare services.
b. disease surveillance, treatment support,
epidemic outbreak tracking and
chronic disease management.
c. bridge gaps between physician and
patients.
14
Disadvantage:
a. Patient’s privacy policies
may lag behind
b. Apps information may not be
100% accurate.
The National Institutes of Health (NIH) defines mHealth as “the use of mobile and
wireless devices to improve health outcomes, health care services, and health research.”

15. Self-monitoring devices
:
Mobile phones are enabling self-diagnostic, enable patient to identify & manage health.
● Netra-G
● Heart monitoring device
● Ear View
● Glucose management
15

16. 4. Internet of Medical Things or Healthcare IoT
16
1. Types:
a. On Body IoMT
b. In-home IoMT
c. Community IoMT
d. Hospital IoMT
1. Definition
An amalgamation of medical devices and applications that can connect to healthcare
information technology systems using networking technologies.

17. Example of IoMT:
17

18. Benefits of Digital Health
● Empowers consumers by
○ leveraging the digital infrastructure, technology support & enables consumers
to manage their own health. 18
● Better Health care: Integration into health care system
● Less is better: Hallmark of digital healthcare system
● Personalized service: More personalized approach for patient
● Preventive Care: Prevents advancement of chronic diseases

19. Challenges of Digital Health
● Funding
● Health literacy
● Inequalities
● Pace of innovation
● Ethics
● Lack of international standardization
● Cybersecurity
● Interoperability of data 19

20. Data protection law in India
● No specific legislation on data protection
● Right to compensation on improper disclosure of personal information (IT
Act 2000 to include section 43A and 72A)
● Puttaswami’s Judgement 2017- “Right of Privacy” as fundamental right
under Article 21.
● Personal data protection, 2019- drafted by justice BN Srikrishna’s
committee 20

21. ● COPAL-19 mobile app.
● The state government has partnered with cloud physician, an indigenously
developed tele-ICU solution to offer its services in Gulbarga Institute of
Medical Sciences (GIMS) and also in Karnataka.
● Remote Monitoring- Care at home for COVID-19 patients
Digital Health and COVID-19
21

22. Journey to NDHM
22
Sustainable
Development
Goals 2016
Achieve universal
health coverage,
including financial
risk protection,
access to quality
essential health-
care services,
medicines and
vaccines for all
National Health
Policy 2017
Outlines specific
goals for adoption
of digital
technologies:
• Develop
registries for
facilities & providers
• Establish a
Federated National
Health Information
Architecture
• Metadata and
Data Standards &
Electronic Health
Record
National Health
Stack 2018
Defined
fundamental
components for
digital health
• Electronic
registries
• Claims &
coverage platforms
• Federated PHR
framework
• Health analytics
platform
National Digital
Health Blueprint
24th April 2019
Implementation
Guidelines .
● Designed a
framework
relating to
digital health
● infrastructure,
building blocks,
● standards &
regulations,
● an institutional
framework
National
Digital
Health
Mission
(NDHM)
15th August 2020

23. ● Complete Digital Health Ecosystem
23
NDHM- A Game changer
● Ability to securely Store and Access medical records
● Enrolling in the NDHM is voluntary;
● DigiDoctor
● Pilots rolled in Six Union Territories

24. 24
Single, Secure Health ID to all
Personal Health Records
App Store
Specialized services for remote
areas/ disadvantaged groups
NDHM Call Centre National ‘Opt-out’ (for privacy)
Digital Child Health
e-Prescription service
Online Appointments
Digital referrals & consultations
Digital Services provided by NDHM

25. 25
Covid Vaccine Intelligence Network (CoWIN)
● A web portal for COVID-19 vaccination & registration
● It displays slots for booking of COVID-19 vaccine available in the nearby
areas. https://www.cowin.gov.in/
On going initiatives in Digital health
Arogya Setu
● Mobile App for helping augment the efforts of limiting the spread of COVID19,
with an objective of enabling Bluetooth based contact tracing, mapping of
likely hotspots and dissemination of relevant information about COVID19
● Lab uploads the test results to ICMR Portal.
● if you test +ve, ICMR Shares your details with AarogyaSetu
● AarogyaSetu Changes your status to COVID+ve (RED) & initiate contact tracing
aarogyasetu.gov.in

26. eSanjeevani
● eSanjeevani is the first-ever online OPD (outpatient) consultation service
offered by the government of India to citizens.
● It includes a structured and safe teleconsultation between a doctor and a
patient through online mode (eSanjeevani OPD). https://esanjeevani.in/
26
On going initiatives in Digital health
Electronic Vaccine Intelligence Network (eVIN)
An integrated solution for System Strengthening and Improving Program
Governance by real-time monitoring on vaccine stocks and storage temperature.
https://evinonline.in/#/

27. e-Raktkosh
● Centralised blood bank management system.
● Launched in 2016
https://www.eraktkosh.in/BLDAHIMS/bloodbank/transactions/bbpublicindex.html
27
Health and Wellness centre
● Launched under Ayushman Bharat in 2018 and revised version in 2020.
● A Doctor-to-Doctor telemedicine service under AB-HCW scheme of GOI, to
provide general and specialised health services in rural areas and isolated
communities.
https://ab-hwc.nhp.gov.in/
Ongoing initiatives in Digital health

28. Health Management Information System
A G2G web-based Monitoring Information System by MoHFW, to monitor the
National Health Mission and other Health programmes and provide key
inputs for policy formulation and appropriate programme interventions.
https://hmis.nhp.gov.in/#!/
28
Integrated Disease Surveillance Programme (IDSP)
To strengthen decentralized laboratory based IT enabled disease
surveillance system for epidemic prone diseases to monitor disease trends
and to detect and respond to outbreaks in early rising phase through trained
Rapid Response Team
https://www.idsp.nic.in/index4.php?lang=1&level=0&linkid=313&lid=1592
Ongoing initiatives in Digital health

29. 29
Rashtriya Bal Suraksha Karyakram (RBSK)
RBSK Web Application captures data of the screening conducted
by the Mobile Health Teams in the health block
It aims to capture the important indicators of incidence and
prevalence of health conditions among children till the age of 18
years.
http://www.nisc.gov.in/
Ongoing initiatives in Digital health
Mera Aspatal
A patient feedback for the services received at the hospital through
user-friendly multiple channels such as Short Message Service
(SMS), Outbound Dialling (OBD) mobile application and web portal.
https://meraaspataal.nhp.gov.in/about_us

30. 30
Nikshay Aushadhi
A web based supply chain management application, developed by
CDAC-Noida, deals with the management of stock of various
Anti- TB Drugs and Lab items required by State-Drug Stores,
District Drug Stores
http://www.nisc.gov.in/
Ongoing initiatives in Digital health
Nikshay
Ni-kshay is used by health functionaries at various levels across the
country both in the public and private sector, to register cases, order
various types of tests from Labs across the country, record
treatment details, monitor treatment adherence and to transfer
cases between care providers. https://www.nikshay.in/

31. 31
Comprehensive Primary Health Care (CPHC), NCD
Application
● Facilitate population based screening for 5 common NCDs (HTN, DM,
breast cancer, oral cancer, cervical cancer)
● Enable data entry across different level of facilities.
● Enable referral and follow-up who were under treatment.
https://ncd.nhp.gov.in/#/login
Drug and vaccine distribution and management system
(DVDMS)
Provision of free generic drugs distribution through public health facilities
particularly for poor and vulnerable group.
https://cdashboard.dcservices.in/CDDB/hissso/Login.cwh
On going initiatives in Digital health

32. 32
On going initiatives in Digital health
Kala-Azar Management Information System (KAMIS)
Monitoring of disease trends, capture every case with accurate
address of residence, irrespective of the place of diagnosis
https://play.google.com/store/apps/details?id=org.kamis
National Programme for Control of Blindness & Visual
Impairment(NPCBVI)
It brings transparency in the processes involved in the NPCBVI
Program and ease the data flow across the hierarchy levels.
https://npcbvi.gov.in/Home

33. National Cold Chain Management Information System (NCCMIS)
1. To generate real time inventory of cold chain equipment
2. To ensure real time tracking of various cold chain indicators like
sickness rate, breakdown
http://www.nccmis.org/about-nccvmrc.html
33
National Viral Hepatitis Control Program
Paperless Recording and reporting system under National
Viral Hepatitis Control Program for Capturing patient
Information and Clinical details for Management of Viral
Hepatitis
https://nvhcp.gov.in/
Ongoing initiatives in Digital health

34. 34
National Injury Surveillance Centre
It collect, compile, analyse & disseminate injury related
information to the communities and the policy makers for
reducing the burden of morbidities & mortality due to injuries &
build capacity for providing quality care to the injury victims.
http://www.nisc.gov.in/
Ongoing initiatives in Digital health
National Identification Number to Health Facility of
India (NIN-TO-HFI)
1. MohFW has initiated a process for generating NIN for all Health
Facilities of India
2. NIN will be random but unique 10-digit number within India
https://nin.nhp.gov.in/about_nin2hfi.php

35. Other ongoing initiatives in Digital health
35
● Drug and vaccine distribution and management system (DVDMS)
● Comprehensive Primary Health Care (CPHC), NCD Application
● Kala-Azar Management Information System (KAMIS)
● National Cold Chain Management Information System (NCCMIS)
● National Viral Hepatitis Control Program
● National Programme for Control of Blindness & Visual Impairment(NPCBVI)
● National Identification Number to Health Facility of India (NIN-TO-HFI)
● National Injury Surveillance Centre
● Pradhan Mantri Matru Vandana Yojana
● Anmol
● Reproductive and child health

36. ● Smart health monitors- collect personalised vital signs and test results in real time.
● Human DNA analysis- enable truly personalised genomic testing and treatment options
for certain genetic disease.
● Mobile health apps- prevents serious diseases by increasing patient engagement,
providing health education and expert guidance from health care providers.
● Virtual reality- Can transform the way of pain management, stress management and
rehabilitation.
36
Future of Digital Health

37. Fewer evidences of Digital health:
Cure Fit: (2016) It offers fitness, nutrition and mental well being solutions through offline and
digital channels. It strengthen its technology platform by offering AI driven health planning,
create its own fitness devices.
DocsApp: (2015) It is an online medical consultation platform. Investors believe that DocsApp
has the platform on-boards only specialist doctors who are then connected with patients in under
30 minutes.
37

38. Prescriptions and Orders Collaboration
hierarchy Partnership
Based on Population Based on individual
Point of care - clinic or Lab Point of care- Patients
Modern Medicine
Traditional medicine
Individual experience dominates Limitless data analysis
Data owned by Institution Data owned and shared by the patients
Expensive Cost driven by MOORE’S Law
Physicians as authority Physicians as guide
Vs
38

39. THANK YOU!!
39

40. Reference:
1. What is mHealth (mobile health)? - Definition from WhatIs.com [Internet].
2. What is Digital Health? | FDA [Internet]. [cited 2022 Aug 14].
3. What is digital health (digital healthcare) and why is it important? [Internet].
SearchHealthIT. [
4. Rashtriya Bal Swasthya Karyakram (RBSK) [Internet].
5. PMMVY | Ministry of Women & Child Development [Internet].
6. Official Website Ayushman Bharat | HWC [Internet].
7. Nikshay [Internet]. [cited 2022 Aug 14]. Available from:
https://www.nikshay.in/Home/AboutUs
8. National NCD Program [Internet]. [cited 2022 Aug 14]. Available from:
https://ncd.nhp.gov.in/#/login
40

41. 9. National Cold Chain Management Information System [Internet].
10. Janani Suraksha Yojana :: National Health Mission [Internet].
11. Governing digital personal data to strengthen reproductive, maternal, newborn and child
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[Internet].
12. Final Report - Lite Version.pdf [Internet].
13. e-RaktKosh:Centralized Blood Bank Management System [Internet].
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15. downloadfile.pdf [Internet].
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