The Independence Day advertisement T dress of the Prime Minister propellingthe National Digi tal Health Mission HD during an extraordinary novel corong ms pandemic emergency,gotten eve anybody's consideration. However, in spite of all his persuasiveness it was not satisfactoryto numerous what's in store in significant terms. Going Digital has no uncertainty been an expression that has frequently been rehashed in various settings in the nation, and up 'til now another "Crucial the wellbeing area, theysat tight for more news to rise. On August 27 we learnt that the Ministry of Health was e pectinginput and open com ments on the draft by September 3.From that point forward the date has been extended by one more week. Indeed that carries on with lackingtime for di Pad amongclinical practi toners, clinic the executives, relationship of different stakehol ders in the medical services division and different individuals from common societyfor anyimportant criticism Some advancement There is no questioningthe reason that catchinginformation identifying with dad patients and its digitizing could help patients, the specialists who join in to them and the medical services facili ties where theylookfor treatment. In certainty numerous States have as of now accomplished a few advancements in these territories with the National Rural Wellbeing Mission (NRHM) and, sub sequently, National Health Mission through the IT arrange associated to mostgeneral wellbeingcommunities even in preliminaryterritories, Personal wellbeing da ta are produced by name till the essential wellbeing place level however ofcommunicated to more elevated levels except collected mathematical information A few patients et alluded to statment dalome specialists or tertiary hos pitals or diagnostic facilities and then they go back to their original practitioner or health centre. They carry back with them and copies of the report or soft copies on their smartphones. Most practi tioners, especially specialists with out data entry staff, often extract only the relevant nature and return the seriAl larsen health facilitate lente and store puterised patient data also for planning treatment, procurement of medicines and consumables Most patients avail medical ser vices from doctors or health care centres in their wn State. But when they seek advanced care i other States or migrate to another State have they not been deprived of medical care? Was it then for want of past rectds or for want of a national network For want of a national policy on the issue Ironically, many tertiary hospitals and medical colleges are little for diagnostic reports from peripheral Centres or even the prescriptions of previous doctors. So what car pens to all the cards created under the Rashtriya Swasthya Bima Boj na and the Ayushman Bharat Prad han Mantri Jan Arogya Yojana! Currently, for pan-India portal ty or for determining insurance Cover, these cards were good enough without the need for the entire medical history at any cen raised platform Without pretending that all hunky dory now, he can still ask this is there a serious problem E with the way patient-related infor mation is managed today" Health is under the State list subject. So did any State government ask for national level digitisation plan to help it in its tasks Has there been a problem of not getting real time State wise aggregated data to the p government of India? Have any a sociations of doctors a civil soci ty organisations asked for digits tion Las not hrush aside the bene fits from a plan of virtually Aad haar like proportions to digitise all data relating to all patients availa ble not just with government and private hospitals but also with diagnostic centres, laboratories and individual practitioners of all systems of medicine The contours The elegance of that proposed ar architecture can send anyone into a daze. An IT consulting firm has been engaged to build a National Health Stack and a registry of over eight lakh doctors, 10 lakh phar macists and over 60,000 hospitals is under preparation. At a later stage, online pharmacies, insu rance companies and other stake holders will be added to the Stack". The Strategy Document states upfront that "Your data is safe and confidential and would be stored only locally'. 'Only anony mised data will be shared up wards, and your consent will be ta ken every time for sharing any personal identifiable information Among the many benefits listed are that it would help patients save the burden of carrying medi cal reports to a specialist or other hospitals'. One can also avail Tele medicine support from renowned specialists if required. And it will be a cakewalk to get your hospital bills settled with insurance cover under government schemes or the higher value policies purchased by you. Overall, the scheme appears to promise an end-to-end, hands free Digital experience. The scheme also intends to re place existing data generation sys tems with a new homogenised software for all machines in the health sector in the country with central processor that will extract the relevant data from individual records. There is a presumption that all the data entered in cash patient's file is accurate. Even en tries made for Aadhaar Cards or Voter ID cards has not been error free. With all medical history re corded as 'truth' in the new soft- ware, insurance companies would be looking for multiple ways to re duce their obligations leading to many disputes. Extensive costs, dilemmas On the face of it, from the side of health -care institutions, the NDHM is merely ensuring custo mission of a new software and changes in current practices of da ta maintenance. However, it would become inevitable for all institu- tion in the government as well as private sector to upgrade their hardware tools apart from consider able costs in customisation and transfer of existing data. In the go government sector there are many existing practices and systems for compilation of data as in the Inte grated Disease Surveillance Pro gramme and the Health Manage ment Information System b te er w D H te tin in in ag pl a fin ap b ta th in he IDSP HMIS) apart from all learning al acquired over the years by staff in those systems and practices. Some lat ger hospitals have already gone for robust and sophisticated soft ware systems such as enterprise Resource planning and would be in a dilemma as to whether they need to scrap the run parallel software provided by the NDHM. Has anyone in the NDHM or the Ministry of Health attempted to es timate the costs of this massive transition to a new system? Public health professionals estimate the cost in thousands of crores for all government and private IPS to upgrade their hardware and con nectivity systems, training of pre sent staff the entry of data afresh apart from other indirect costs. Among independent practitioner ers in allopathic and the Indian systems of medicine who run small dispensaries especially in ru ral areas, there is no practice of even staring patient data on com puters. It is largely based on mu mutual trust and personal memory. For most of them, it is not a feast ble option to enter data in compu ters on their own or engage data entry operators merely to comply with the digitisation protocols. Data leakage How long would the system pro tect its data of many millions get ting stored in the decentralised system holding transferable data? f Informed consent may mean noth ing to a patient or relatives even in - normal times let alone in a time of medical emergency. Even highly educated and rational people agree to part with their contacts. photographs and other data to avail nominal or momentary bene fits offered by some smart mobile apps. Informed consent is too much of a luxury for the vulnera ble and a poor defence against da - - ta leakage. Public health practitioners at the grass-root level would conti nue to wonder if digitisation is the immediate problem facing the health sector or the best way to go 3 about addressing data gaps. In their eyes, what millions face in the country are unreliable health- care facilities in both the gvern- ment and private sectors, difficult e des in getting timely care, availa bility of beds and hygienically - maintained hospital premises. availability of doctors physically or on line, and the continuous ne neglect of preventive and communi ty health initiatives. If they oppose a new plan, it could either be be cause of its doubtful benefitS to pa patients or because of worries re 1 regarding data leakage. They may be > blamed for trying to delay the in evitable, the inexorable march to digitization. Perhaps they need to discover that data is the only cure for all our ills Per content de rendement:
1 where a secretary to the Gawramwf Chhattiert.
† Antony pediatrician and a public Health professional red LINICEF and the State Health Resource Centre, - Chhattisgarh
0 Comments