Please see Chapter 3 of 12th Five year Plan. If we organise ourselves synergistically in implementing this plan our country can achieve a lot .
Chapter-3: Health Information Systems
3.1. The overarching goal is to develop a HIS which can regularly track the progress of the country in achieving the eight national health outcome indicators, and in identifying areas and populations which lag behind on health indicators, with sufficient accuracy, so as to enable remedial action. To achieve this goal, the HIS has to necessarily rely on universal vital registration, and the networking of all health service providers, public and private laboratories. Data fidelity should be assured by triangulation with data from periodic surveys and community based monitoring, which should continue with a greater frequency. Strict compliance with the right of privacy should also be maintained.
3.2. A composite HIS should incorporate the following:
3.2.1 Universal registration of births, deaths and cause of death. Vital registration provides base-line data on cause specific mortality at national and disaggregated levels. Maternal and infant death reviews should be integral components of the system.
3.2.2 Nutritional surveillance, particularly among women in the reproductive age group and under six children, linked to the ICDS Programme.
3.2.3 Disease surveillance based on reporting by providers and clinical laboratories (public and private) to detect and act on disease outbreaks and epidemics.
3.2.4 Out-patient and in-patient information through Electronic Medical Records (EMR).
This will help provide the best care based on Standard Treatment Guidelines, reduce response time in emergencies, support the organ retrieval and transplantation programme and improve general hospital administration. It would also help estimate burden of disease and facilitate policy decisions at State and national levels.
3.2.5 Data on Human Resource within the public health system.
3.2.6 Financial management in the public health system. This will help streamline resource allocation and transfers, and accounting and payments to facilities, providers and beneficiaries. Ultimately, it would enable timely compilation of the National Health Accounts on an annual basis.
3.2.7 Use of Communication and Information Technology (ICT) in medical education by promoting a national repository of teaching modules, case records for different medical conditions in textual and audio-visual formats for use both by the teaching faculty, students and practitioners for Continuing Medical Education.
3.2.8 Tele-medicine and consultation support to doctors at primary and secondary facilities from specialists at tertiary centres.
3.2.9 Nation-wide registries of clinical establishments, manufacturing units, drug-testinglaboratories, licensed drugs and approved clinical trials to support regulatory functions of Government.
3.2.10 Access of public to their own health information and medical records, while preserving confidentiality of data.
3.2.11 Programme Monitoring support for National Health Programmes to help identify programme gaps or areas where there are greater challenges. The challenge of the 12th Plan is how to move towards the larger vision, from the place where the country is today, while respecting the different levels of subjective and objective readiness of stakeholders within the health system and in terms of available health technologies. To facilitate the transition, the information processes and systems existing in NRHM should be reviewed, in order to make the shift to the proposed new arrangement as smooth as possible.
3.3 The 12th Plan should, therefore, aim to achieve the following:
3.3.1 The MoHFW, in consultation with the Department of Information Technology, should mandate, in a participatory and scientific way, the data definitions, data standards, data quality requirements and standards of interoperability, which all publicly financed applications of information technology in the health sector must necessarily subscribe to.
A certification and monitoring mechanism should be put in place to check and enforce compliance with the HIS standards. A data policy should also be put in place that would define how long the health data must be stored, in what electronic form and with what backups. It should also lay out provisions detailing both the right of access and the right to privacy and security of information. The Central Government would also have to develop procurement policies, which permit open source technologies and which allow arrangements that could support software that is constantly evolving.
3.3.2 The MoHFW should encourage and support the development and deployment of the above mentioned data systems in a decentralized way. There has to be data sharing across systems so that the service providers do not have to re-enter the same data element. For example, if malnutrition data of a block is available on one system and the deaths and incidence of acute respiratory infection are available on another system, it should be possible to collate the data against beneficiary details, and make it accessible to both users in a seamless manner. The approach in the 12th Plan should be a massive expansion of the integrated use of health informatics by permitting multiple systems with well-defined and regulated standards at each level or institution. This would help the user/institution in accessing information, which is most useful at that level.
3.3.3 Development of such State level and programme specific HIS should be financed primarily under the NRHM. But financing should be conditional on the systems being consistent with the national standards and the national health-care IT architecture. Technical support should be made available to States to articulate the system requirements, develop appropriate procurement procedures and subsequently to test and certify the software for functionality, security and compliance with the national data standards. States that do not have the capacity to build their own systems in any of the areas listed above can choose from a basket of open source applications available with the Central Government and adapt and deploy it for their use. The emphasis on all such software development should be on the use of the information at all levels, and not on information gathering as an end in itself.
3.3.4 The MoHFW should have three national web-portals – one for collecting information related to health management, another for its regulatory and stewardship functions and the third as a public interface on health information and for health promotion. These could be integrated into one, but to prevent information overload and in order to maintain user friendliness, it is perhaps best to keep them as three separate portals with interconnectivity. These web-portals would be able to communicate with and complement State
systems and acquire their information needs from the latter.
3.3.5 The MoHFW should specify its minimum information requirements for policy, for resource allocation and for management purposes and the States should ensure that their systems are designed to deliver this electronically to the web-portals at desired levels of frequency and quality. While the State and District health systems are designed primarily for local action, they should also be able to generate the requisite information and send it in the format required by the Centre.
3.3.6 States should be encouraged to build HIS by upgrading their existing routine data collection systems. Facilities, their staff and other professionals should be trained to handle and benefit from the opportunity offered by better access to data.
3.3.7 Some of the States are ready to make the transition to EMR and they should be encouraged to do so. In case of other States, EMR could be introduced only for in-patients or for certain category of patients who need sustained and portable follow-up records. The emphasis at this juncture should be on generating public health data requirements through IT resources.
3.3.8 The major portion of public investment in the field of information technology in healthcare should go into institutional capacity building for understanding and use of information. Incurring large expenditures on hardware and software without making matching inputs in capacity development and institutionalization would be an error. As part of this, every State should have skilled human resource at both the State and District levels. This would require a mix of those with IT skills and those with public health informatics skills. Statisticians and demographers have a role to play, but without a good grasp of public health informatics as also information technology, they would be unable to contribute to the changing nature of this area of work.
State specific centres for health information, either stand-alone, or embedded in existing institutions would be essential, along with District teams of three to five persons for managing information flows and interpreting information. The resources available with Programme Management Units under NRHM could be augmented for this purpose.
3.3.9 The use of ICT in health education, public health status analysis and in the generation of health related research should be expanded. These three functions should be located in appropriate national centres.
3.3.10 Information generated from the proposed HIS should be used at all levels to plan, execute and evaluate performance.
3.3.11 A computer with internet connectivity should be ensured in every PHC and all higher health facilities in this Plan period. Connectivity can be extended to Sub-Centres either through computers or through cell phones, depending on their state of readiness and the skill-set of their functionaries. All District hospitals should be linked by tele-medicine channels to leading tertiary care centres, and all intra-District hospitals should be linked to the District hospital and optionally to higher centres. The availability of “Skype”, and other similar applications for audio-visual interactions, makes tele-medicine a near universal possibility and could be used to ameliorate the professional isolation that health personnel posted in rural and remote areas face.
3.3.12 M-Health, the use of mobile phones to speed up transmission of data and reduce burden of work in reporting, to improve connectivity between providers, and as a vehicle of health communication should be built upon. Services like information on empaneled providers in an area, advice on the nearest provider in the event of an emergency, advice on healthy living and preventive practices need to be made available on one standard number (like 100 for police ) in each State. This could be the first level of information before the patient chooses his healthcare service provider.
3.3.13 With respect to governance, the advantages of transparency in Government processes are many and obvious and these should be fully utilized. Not only is it a matter of compliance with the Right to Information Act but also adds to citizens’ participation, trust
and goodwill. The opportunities offered by use of IT in ensuring accountability of peripheral staff or in prevention of fraud, as in checking on payments to beneficiaries, need to be carefully evaluated, before it is generalized. At any rate, policing should at best be a minor, collateral function of ICT in the health sector.
3.3.14 All ICTs in health, whether in the States or at the Centre should be professionally evaluated for performance against stated objectives and for their contribution to national health outcome indicators.
3.3.15 Assets created and experience gained in the Integrated Disease Surveillance Project should be used to build a complete HIS outlined above.
Download Report of the Steering Committee on Health for the 12th Five Year Plan.