Digital Health.pptx

Editor's Notes

• #6: 1987- 1st medical diagnosis over telephone – a child was diagnosed with a viral infection. 1956 Ultrasound imaging 1st clinical usage of ultrasound imaging in Glasgow, Scotland. 1977- DNA Sequencing Sanger’s data manually entered into a computer after many hours of interpretation. 1982 Artificial Heart Transplant 1st successful transplant of artificial heart (Jarvik-7) by Dr William DeVries. 1989- International Medical Informatics Association Independent organization that promotes the application of information science. 2005 Digital Therapeutics Welldoc developed web & mobile-based solutions to for management of chronic disease. 2007- Mobile Health Gadgets Fitbit was invented, a mobile device that monitors the user’s health. 2017 Digital Health Authority The US Food & Drug Administration (FDA) launches ‘Digital Health Center of Excellence’
• #7: Digital health is a broad, multi-disciplinary concept that links technology with healthcare. It encompasses digital care programs, technologies with health, healthcare, living, and society to enhance the efficiency of healthcare delivery and to make medicine more personalized and precise. Digital health has a broad scope and includes the use of wearable devices, mobile health, telehealth, health information technology, and telemedicine. Digital Health has been gaining momentum because it is envisioned to:
• #8: Telemedicine-Remote medical consultation EHR-Electronic storage of patient/population health informations mHealth-Mobile health refers to use of mobile phone or wireless technology in medical care Self Monitoring Devices-Wearable medical devices Internet of medical things-A combination of Mobile technology, wearables & telemedicine Robortic assisted Sx- Using assistance of robot doctors perform surgical procedures more efficiently Organ On Chips-New treatment/ Medicine at cellular level that can be best studied on chips instead on humans/ animals.
• #9: Telemedicine refers specifically to the practice of medicine via remote means, telehealth is a blanket term that covers all components and activities of healthcare and the healthcare system that are conducted through telecommunications technology. Telehealth The delivery of healthcare, health education, and health information services via remote technologies
• #10: An electronic health record is the systematized collection of patient / population electronically stored health information in a digital format. These records can be shared across different health care settings. EMR - Digital version of a patient's chart EHR contains the patient's records from multiple doctors and provides a more holistic, long-term view of a patient's health Continuty of providing care- Note important information for later use Improtant chronic diseases, like HTN, DM or in followup like Surgery. Patient safety Prevent something detrimental for patient by using previous information like Drug allergies, list of current medication etc. Communication between providers Referral to specialist or other physician Communication b/w nurses and physician, or two physician or pharmacist and physician. Transfer from one hospital to another Medico-legal purpose Court evidence against malpractice. (what was provided to patient? Why? When? And by whome?) Was care provided upto professional standards. Claims and reimbursements: What services are provided to patient how/ how much will be hospital/ doctors be paid, Audit of medical records by payers. Patient’s use: Health insurance claim Self education and self care Clinical research: Find way to improve health care through new knowledge.
• #11: Continuty of providing care- Note important information for later use Improtant chronic diseases, like HTN, DM or in followup like Surgery. Patient safety Prevent something detrimental for patient by using previous information like Drug allergies, list of current medication etc. Communication between providers Referal to specialist or other physician Communication b/w nurses and physician, or two physician or pharmacist and phyhscian. Transfer from one hospital to another Medico-legal purpose Court evidence against malpractice. (what was provided to patient? Why? When? And by whome?) Was care provided upto professional standards. Claims and reimbursements: What services are provided to patient how/ how much will be hospital/ doctors be paid, Audit of medical records by payers. Patient’s use: Health insurance claim Self education and self care Clinical research: Find way to improve health care through new knowledge.
• #12: An individual's official health document that is shared among multiple facilities and agencies. The role of EHRs is becoming increasing influential as more patient information becomes digital and larger numbers of consumers express a desire to have mobile access to their health records.
• #13: EMR mostly refers to electronic documentations of medical care at one visit EHR refers to electronic documentation that is longitudinal in nature. For eg:
• #14: So the EHR will also remind patients having chronic disease about regular Check-ups and drunk intake.. And also in patient admission reminding doctors about allergies and other factors. Even Facebook helps in reminding birthday’s of near and dear one’s EHR can be Doctor’s facebook in reminding patients disease condition.
• #15: mHealth – also known as mobile health - refers to the practice of medicine and public health supported by mobile devices such as mobile phones, tablets, personal digital assistants and the wireless infrastructure mHealth vs. telehealth While there can be overlap between Telehealth and mHealth, the two are not interchangeable. The main difference is that mHealth is delivered exclusively via mobile devices. mHealth refers to the concept of mobile self-care — consumer technologies like smartphone and tablet apps that enable consumers to capture their own health data, without a clinician’s assistance or interpretation. While telehealth can be delivered on mobile platforms, it refers to the delivery of remote care via electronic information and telecommunications technologies. epidemic outbreak tracking (like arogyasetu) PRIVACY Additionally, not all mHealth apps are compliant with the Health Insurance Portability and Accountability Act (HIPAA), meaning there is no guarantee that a user's health information will be protected or that users will be notified if there is a data breach. STUDIES 2018 consumer survey from health insurer United HealthCare Services Inc. found that 36% of Americans used the internet or a mobile app to compare healthcare services during the last year, with Millennials being the most likely to do so at 51%. a Deloitte study of 4,530 healthcare consumers and 624 physicians found that half of all respondents used wearables and other technologies to track their health information, and 53% said they shared that information with their physician.
• #16: A wearable medical device can be defined as a device that is autonomous, noninvasive, and that performs a specific medical function such as monitoring or support over a prolonged period of time. Netra-G is a device that attaches to smartphones and enable patients to perform own eye test by measuring the refractive error of eye. Heart monitoring device- That snaps into iphone and wirelessly communicate between app and phone Resting your finger, the app recognises and performs ECG. Ear View- Ear canal and ear drums can be viewed and recorded and is sent to physician remotely. Glucose management- The meter automatically sync data with diabetes manager app, tracking glucose, insulin and carbs and also charting patient’s glucose level over time Other apps includes: Diet and nutrition app Fitness app Wellness app Patient and provider care app Medical device accessory app
• #17: What is IoMT? An amalgamation of medical devices and applications that can connect to health care information technology systems using networking technologies. It can be a combination of telemedicine, mobile technology, wearables, including ECG monitors. Many other common medical measurements can also be taken, such as skin temperature, glucose level, and blood pressure readings. The Internet of Medical Things (IoMT) is the collection of medical devices and applications that connect to healthcare IT systems through online computer networks. Medical devices equipped with Wi-Fi allow the machine-to-machine communication that is the basis of IoMT. IoMT devices link to cloud platforms such as Amazon Web Services, on which captured data can be stored and analyzed Types On-body IoMT: Wearable medical devices that are connected to remote tracking or monitoring systems and can often be used outside of the home as people live their normal lives. (Like apple watch for self monitoring of Spo2, PR etc..) Consumer on-body IoMT devices are wearable devices that anyone can buy to track health metrics for both personal use and for sharing with healthcare providers. In addition to tracking a standard metric, such as heart rate, these devices can be early warning signs for more serious health conditions. For example, the Apple Watch can warn users about irregular heart rhythms. Clinical on-body IoMT devices are like the consumer devices but afford a wider array of sensor options. For instance, glucose sensors can be worn by diabetic patients to alert them to fluctuations in glucose levels. Many of these devices can share data directly with a patient’s doctors to ensure they get fast and accurate treatment. 2. In-home IoMT : In-home IoMT allows people to transmit medical data from their home to other locations such as their primary care provider or a hospital. (Like Glucometer that i showed previously gets connected with phone and helps in transfer the information to cloud server to the concern physician or use of medical devices to transmit metrics such as blood pressure or oxygen saturation from recently discharged patients to their hospital for review by their doctors.) 3. Community IoMT: Use of IoMT devices throughout a broader town or geographic area. (For example, mobility services are devices used to track patients while in transit in a vehicle, suppose to transport medicines or vaccine to remote areas. Similarly, emergency response intelligence systems are used by paramedics and first responders to track patient metrics outside of the hospital setting.) 4. Hospital IoMT (Example: Smart ICU system that will notify the treating physician about patient’s vitals)
• #19: Digital health should be integrated into health care system to demostrate log term improvement over traditional approach. The hallmark of digital healthcare system is not better care, but less need of professional care. Digital health make medicine more personalized for patient. Using wellness app enables patient to track weight, calorie count and BS level and can have more control over their health. Preventive Care: Prevents advancement of chronic diseases
• #20: Funding : It is always an isuue for a devoloping country to build a new set-up. Health Literacy: is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others. In a country like India where literacy rate is 74%, It is very difficult to educate a community with lower acceptance. Inequalities: Inequalities of opinion in a population matters when comes to Digitising health structure, where traditional methods are more accepted than digital technology. Pace of Innovation: Lags behind because of improper standardization and lack of proper ethics while giving or getting a tele-consultation or using internet for maintaining a proper chart of patient details. Where expectations are a mile far from the development. Ethics: Giving a teleconsulation means only inspecting patients condition and examining verbally which someway or the other differs from the Oath that we all took. And also data confidentiality which is not in control of Physician. Lack of International standardization Cybersecurity: In India there is no Data Protection law, so cybersecurity is a big issue in a densely populated country like India. Interoperability of Data: Which means accessibility of Data from anywhere at any given point of time, for that a common cloud space and a ecosystem is necessary, so that details of a patient can be fetched by the treating physician. India is on its way of building up a ecosystem that we will know in further slides.
• #21: Critical personal data should be processed only in India, provision of fata protection authority
• #22: COPAL-19: Mobile app to track Covid patients at the hospital in real time. They will also be able to track discharged patients who have potential to become plasma donor 28 days post recovery (AIIMS, IIT New Delhi) 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). The firm provides solution to manage critically ill Covid-19 Patients using intensive EMR, Audio-visual and alert system. Remote Monitoring- Care at home for COVID-19 patients- isolating at home with mild case or pre symptomatic cases of COVID-19 by treating medical officer provided with a medical kit (with a thermometer and an oxygen saturation probe), Daily monitoring of vitals by trained nurse twice a day, a tele-review/ critical alert system with a doctor every third day as well as home delivery of medicine
• #23: On 1 January 2016, the 17 Sustainable Development Goals taken by 193 country members Under NITI Ayog 1 No Poverty 2 Zero Hunger 3 Good Health and Well-being 85 4 Quality Education 5 Gender Equality 6 Clean Water and Sanitation 7 Affordable and Clean Energy 8 Decent Work and Economic Growth 9 Industry, Innovation and Infrastructure 10 Reduce Inequalities 11 Sustainable Cities and Communities 12 Responsible Consumption and Production 13 Climate Action 14 Life Below Water 15 Life on Land 16 Peace, Justice and Strong Institutions 17 Partnerships for the Goals
• #24: Pilots rolled in Six Union Territories (Andaman & Nicobar, Chandigarh, Dadra & Nagar, Daman & Diu, Lakshadweep, Ladakh, Puducherry) Complete Digital Health Ecosystem with Health-ID, DigiDoctor, Health Facility Registry, Personal Health Records, e-Pharmacies and Telemedicine Ability to securely Store and Access medical records (prescriptions, diagnostic reports, discharge summaries) Enrolling in the NDHM is voluntary; data can only be shared after approval from individuals Digi Doctor – He/she will be the one who will be responsible for providing healthcare services across the country. An interested healthcare professional can act as a digital doctor to provide prescriptions to patients sitting in a different location altogether. He/she will be assigned free digital signatures which can be used to prescribe medicines. The National Digital Health Mission (NDHM) encompasses: Health and Well-being for all Health and Well-being at all ages Universal Health Coverage Citizen-centric Services Quality of Care Accountability for Performance Efficiency and Effectiveness in the delivery of services Creation of a holistic and comprehensive health eco-system
• #26: Reproductive & Child Health (RCH) "an augmented version of MCTS" application has been designed for early identification and tracking of the individual beneficiary throughout the reproductive lifecycle. Application facilitates timely delivery of full component of antenatal, postnatal & delivery services and tracking of children for complete immunization services. RCH portal meets the requirements of RMNCH program with provision of Family Planning services, Quality & comprehensive ANCs and alerts to ANMs, Beneficiaries and Health Managers.
• #27: 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 to ensure continuum of care. Enable referral and follow-up who were under treatment.
• #28: Health and Wellness centre Ayushman Bharat (AB) is an attempt to move from sectoral & segmented approach of health service delivery to a comprehensive range of health care service. It aims to undertake path breaking interventions to holistically address health (covering prevention, promotion & ambulatory care), at primary, secondary & tertiary level. Ayushman Bharat adopts a continuum of care approach, comprising of two inter-related components. The first component, pertains to creation of 1,50,000 Health and Wellness Centres which will bring health care closer to the homes of the people. These centres will provide Comprehensive Primary Health Care (CPHC), covering both maternal and child health services and non-communicable diseases, including free essential drugs and diagnostic services. The AB-HWC portal captures facility wise data on profile of HWCs and service utilization detail at these health facilities. The portal provides real time updates to the states and districts on their progress in fulfilling the functionality criteria for operationalizing HWCs. The Portal supports states & districts to monitor their progress in operationalizing HWCs.
• #29: Health Management Information System (HMIS) is a Government to Government (G2G) web-based Monitoring Information System that has been put in place by Ministry of Health & Family Welfare (MoHFW), Government of India to monitor the National Health Mission and other Health programmes and provide key inputs for policy formulation and appropriate programme interventions. HMIS has been utilised in Grading of Health Facilities, identifications of aspirational districts, review of State Programme Implementation Plan (PIPs), etc. The analytical reports generated through HMIS also provides gap analysis and evidence based course correction. HMIS was launched in October 2008. Currently, around 2 lakh health facilities (across all States/UTs) are uploading facility wise service delivery data on monthly basis, training data on quarterly basis and infrastructure related data on annual basis on HMIS web portal. HMIS captures facility-wise information as follows: Service Delivery (Reproductive, Maternal and Child Health related, Immunisation family planning, Vector borne disease, Tuberculosis, Morbidity and Mortality, OPD, IPD Services, Surgeries etc. data) on monthly basis. Training Data (Trainings imparted to Medicals and Paramedics staff at District and State level data) on quarterly basis. Infrastructure (Manpower, Equipment, Cleanliness, Building, Availability of Medical Services such as Surgery etc., Super Specialties services such as Cardiology etc., Diagnostics, Para Medical and Clinical Services etc. data) on annual basis.
• #30: National Programme for Control of Blindness & Visual Impairment(NPCBVI) Information Technology, in the context of the NPCBVI program entails the design and functioning of the Management Information System (MIS). It brings transparency in the processes involved in the NPCBVI Program and ease the data flow across the hierarchy levels. The NPCBVI-MIS is accessed and used by each and every stakeholder through the NPCB website (npcbvi.gov.in). Information Technology or MIS, is the enabler to ensure data availability to all stakeholders and hence streamline necessary approvals and claim reimbursement process. Rashtriya Bal Suraksha Karyakram (RBSK) RBSK Web Application captures data of the screening conducted by the Mobile Health Teams deployed under the program in the health blocks. The application captures details of all institutions visited by the teams and the screening conducted by them during the visits. The children identified with certain health conditions are referred to health facilities for free treatment. The applications aims to capture the important indicators that indicate the incidence and prevalence of health conditions among children till the age of 18 years.
• #31: NI-KSHAY-(Ni=End, Kshay=TB) is the web enabled patient management system for TB control under the National Tuberculosis Elimination Programme (NTEP). It is developed and maintained by the Central TB Division (CTD), Ministry of Health and Family Welfare, Government of India, in collaboration with the National Informatics Centre (NIC), and the World Health Organization Country office for India. Ni-kshay is used by health functionaries at various levels across the country both in the public and private sector, to register cases under their care, order various types of tests from Labs across the country, record treatment details, monitor treatment adherence and to transfer cases between care providers. It also functions as the National TB Surveillance System and enables reporting of various surveillance data to the Government of India.
• #33: Drug and vaccine distribution and management system (DVDMS) Provision of free generic drugs distrubution through public health facilities is one of the most cost effective way to reduce out of pocket expenditure particularly for poor and vulnerable group. Electronic Vaccine Intelligence Network (eVIN) eVIN is an integrated solution for System Strengthening and Improving Program Governance. The integrated solution combines: Technology: Real-time information on vaccine stocks and storage temperature through the eVIN application and temperature loggers Governance: Efficient vaccine logistics management by systemizing record keeping through standardizing stock & distribution registers which are mapped onto eVIN app Human Resources: Strengthening cold chain network by building capacities of vaccine cold chain managers at each level
• #34: National Cold Chain Management Information System (NCCMIS) Sickness Rate: decrease the infectivity by 2% Breakdown of Coldchain: It takes a chain of precisely coordinated events in temperature-controlled environments to store, manage and transport these life-saving products 3 . To support MoHFW in taking various policy decisions for Cold Chain management in the country
• #35: National Identification Number to Health Facility of India The Ministry of Health & FW has initiated a process for generating National Identification Number for all Health Facilities of India (NIN-2-HFI). NIN will be random but unique 10-digit number within India. In order to identify the geographical location of the health facility, attributes like state, district, taluka, village codes based on MDDS (Meta Data & data Standards) will be attached to NIN initially. More attributes as per requirements can be added as and when such need arises. The Center for Health Informatics has developed the NIN Web Portal to generate NIN-to-HFI. End-users will be able to confirm by giving NIN through central database and will confirm its available attributes, if found correct. This site has been developed to confirm and verify the existence of the facility. Since NIN will be permanent unique 10-digit number, verification of health facilities and their attributes is essential. Software has been facilitated to verify the base data. Once base data is verified, NIN will be permanent for that Health Facility and all the Health applications will use NIN in their databases to ensure inter-operability among applications. National Injury Surveillance Centre Main objectives of National Injury Surveillance Centre (NISC) is to collect, compile, analyse & disseminate injury related information to the communities and the policy makers for reducing the burden of morbidities & mortality resulting due to injuries and to build capacity for providing quality care to the injury victims.
• #36: ANMOL- A multifaceted mobile tablet based android application of Ministry of Health & Family Welfare (MoHFW), GoI for early identification and tracking of the individual beneficiary throughout there productive lifecycle. Application would help to ensure tracking of beneficiary for proper health care and promote family planning methods being adopted by them. System also facilitates to ensure timely delivery of full competent of antenatal, postnatal & delivery services and tracking of children for complete immunization services. ANMOL application has been designed to meet the requirements of the RMNCH program by incorporating additional functionality and features of the RCH. Reproduction and child healthcare (RCH): Reproductive and Child Health (RCH) portal to capture information on all RCH related services including family planning, maternal health, Child health and immunization. Designed for early identification and tracking of the individual beneficiary throughout the reproductive life-cycle.
• #37: Future of Digital Health Telemedicine- 1,50,000 health and wellness center along with telemedicine (Digital health India) Electronic medical records- Can digitalise patient’s information coming from various location at one place. Artificial intelligence Robotics-That will help assisting physicians in various surgical procedures remotely.
• #39: MOORE’S Law- Eg- The law also states that, as the number of transistors increases, the cost per transistor falls. So not only will the processing power of computer chips grow exponentially, but the cost per transistor will also decline exponentially