India with a current population of 1.25 billion is posed to be the highest populated country with 1.6 billion by 2050. Indian public health planners have a huge challenge ahead – to serve and keep population healthy. Health care service resources will not increase in proportion to this population increase. The situation of high geographical disparities in health and wellbeing of population in addition to the demographic and epidemiological transitions taking place during this period will demand continuous spatiotemporal adjustments in plans and realignment of health care resources allocation. To address these challenges, health-planning process needs to evolve by provisioning maximum use of Information and Communication Technology (ICT) in health care delivery and public health decision making at every level. This is to deliver right health services to right people at right place and on right time.
Many academic literatures point to the importance of strategic partnerships between the ICT and healthcare sectors. To transform conventional information system into modern, real time and contextual public health information system, there is a need to strengthen health care data/ information collection, exchange and analysis using range of following available ICT areas: application service provision, database and software support, electronic health records, health information systems, intelligence systems, Geographic information systems, security services and tele-health systems.
Despite having a big ICT talent pool, infrastructure and other resources advantage, use of ICT in health care in India has not been successful and varies state to state. Low use of ICT in health care contributes to poor patient care, poor and slow data reporting to HMIS lead to delayed, inefficient and insufficient public health response. In a BMJ blog the authors documented their experience with vital registration system in Karnataka state in India. Though Karnataka has 90% vital registration recording, full potential of such data for public health decision and policy making remains unachieved. It is a general perception among health system researchers in India that private and unorganized health care sectors possess biggest challenge in successful use of ICT in health care. Many success stories both at international level and within India show that improvement in health care delivery owing to successful use of ICT. It boosts the utilization of state run health services; encourages private sector to join ICT wagon and will minimize or gradually eliminate unorganized and uncertified health care sector. In Tamil Nadu, HMS was launched in May 2005 that contributed to improved health care and allowed health workers, even in remote areas, immediately report disease incidence data to health officials. In turn, health managers were able to quickly analyze information about suspected cases, share technical information and resources, and initiate an informed response.
A careful and systematic review of documentation of various health care information systems around the world provides insight into factors contributing to the ineffective ICT and HMIS implementation. These factors include failure to take into account the social and professional cultures of healthcare organizations; inadequate attention to the need for education of users; underestimation of the complexity of routine clinical and managerial processes by IT developers; lack of commitment among stakeholders due to different expectations; not learning from past project failures; low understanding of ICT for patient care and in clinical setting by clinicians and health care practitioners and similarly missing health care context knowledge among IT professionals and data analysts; and not linking various health care and demographic information systems.
To reap the benefits of ICT in health care and public health, some fundamental measures are required to create ICT awareness and data culture among health care provider and public health decision maker. Measures as simple as introduction of curriculum on best use of ICT in medical courses can have huge influence on aspiring clinicians and health workers to record, organize, use and share patient information. Other successful measures being used around the world include developing a dedicated cadre of public health data scientist (Computer science + Statistics + Epidemiology + Public health + medical knowledge) – to collect, analyse, synthesize and transform public health data into intelligence to support timely evidence-based decision making at every level; establishing a national level health intelligence unit which collect information in real time from different sources; expanding and including the use of Geographical Information system to create public health geo-intelligence for rapid detection of health event of major concern ; improving health risk communication to public using various m-health initiatives; and integrating various health information system including census and vital registration system.
In conclusion I would like to say, careful, smart and contextual integration of ICT in health care service delivery and resulting improved HMIS should be core and prioritized strategies to response complex health need of a country of over billion people with diversified social and cultural practices. India needs to do it and do it now.
Ajay Goel was a student of e-learning course in Public Health Management(ePHM) conducted by Institute of Public Health, Bangalore, India.
Disclaimer: IPH blogs provide a platform for ePHM students to share their reflections on different public health topics. The views expressed here are solely those of the authors and not necessarily represent the views of IPH.