Tuesday, 11 November 2014

Why India needs Healthcare Information Technology

India with its population of  over 1.25 billion firstly has  a challenge in keeping a track of this vast population's health, much less keep them healthy. The major reason for this is lack of timely, accurate and reliable healthcare information in today's paper world

State of Health in India
In healthcare India ranks very poorly, even compared to our neighboring countries . For example in the following health indicators

Maternal Mortality Rate : defined as number of women who die during pregnancy and childbirth, per 100,000 live births. India is ranked at 142 with a rate of 200 maternal deaths per 100,000 live births, which is worse than Bhutan ( 180/ 100,000) or Nepal (170/100,000)

Infant Mortality Rate : defined as number of children less than one year of age per 1000 live births. In India the figure is 52 per 1000 live births, ranking us at number 144 in the world behind Nepal (ranked 132) and Bangladesh (ranked 142).

Present state of healthcare information collection in India
At present it is estimated that it takes about six months for the health information to be collected , collated and analyzed to prove that a given region in India had an epidemic. By that time the disease (with most being self limiting) would have struck, had its toll of morbidity and  mortality and run its course. With most data collection being paper based this delay costs India loss of lives and  productivity with high morbidity, especially in rural areas ( in urban areas- private hospitals and clinics have a process of notifying the public health authorities for notifiable diseases, hence epidemics are identified earlier in urban areas) .

To top it all there is general  disbelief in the official published health statistics in India. For example, official data claimed that Malarial deaths in India was only 1,023 in 2010, however a Lancet published  study showed the figure to be actually 46,800. Following the Lancet article, the official data agreed that they had their figures off by twenty to thirty times.  Even for a common disease like Cholera, which strikes every monsoon in endemic areas along the Ganges and Brahmaputra, the official estimate for India is 3,631 cases per year, while research has shown this to be about 22,200 per year.   

While the immediate reaction is to blame the public health authorities and Government in India, one has to understand the limitations in a paper world to collect health information of 1.2 billion people across 3,20,000 square kilometers. Compare that to collection of information electronically - an electron can travel around the world in about 19 seconds.

The solution - Healthcare Information Technology (HIT)
The solution is to produce healthcare information in a timely manner with accuracy and reliability. To achieve speed it is best to do so with Information Technology - hence HIT. To achieve accuracy and reliability  , it is best if the patient's data is put into the HIT system by the providers of healthcare such as doctors, nurses, pharmacist etc at the point of care. This patient level data can then be collated and processed to get timely , accurate and reliable population based healthcare information .
 In addition HIT systems provides the power of IT to healthcare such as giving alerts for drug-drug interactions, duplication in lab tests and bringing about efficiency  in processes and workflows in a healthcare setting, producing reports quickly which will help in planning and deployment of healthcare. It is estimated that healthcare doubles in knowledge every seven years and it is difficult for doctors to keep up. With HIT it will be possible to keep up with the latest and deploy best practice evidence based medicine applicable for India.

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