Objectives:
This project aims to promote transparency (at the same time nurturing patient
privacy) and develop a common platform for shared learning and practice between
hospital and community based health professionals as well as patients and other
stakeholders.
Strategy:
A major deliverable from this project is
the establishment of community based ‘electronic registration and follow up’
through E-Health-ATM centers integrated to tertiary or even district Hospitals
in India..
These E-health-ATM centers are managed
by interested and trained volunteers residing in the community also labeled as
‘trained community health entrepreneurs’ TCHEs (first mentioned here: http://www.missionarogya.org/p/arogyaudhc.html)
and their job is to a) interview patients, record their history and past
investigation records and b) further upload the relevant individual patient
details onto an online open health record to create individual health records
such as is already available here: http://www.udhc.co.in/INPUT/input_directory.jsp after removing ‘patient identifiers’ to
nurture patient privacy.
To develop the HealthATM analogy (as a
populist illustration for our workflow) this process can be thought of as analogous
to depositing your money (data) in a bank. The physicians (bank employees in
various roles) managing the website (bank) would then add informational
solutions to not only tackle the current problems of these patients but also
support them with regular informational continuity for the future. Please see
this output page (HealthATM output) http://www.udhc.co.in/SOLUTION/solutionList.jspwhich is analogous to getting your money back from the bank with interest.
The
role of TCHEs
This can be thought of as analogous to
Bank policy Agents (LIC policy agents in India?) but in this case they not
only market and sell their bank services but also add to its major work input
in terms of uploading the initial deposit of patient inputs in the form of raw
unstructured or semi structured narrative data (sample this real data uploaded here
in Hindi-English: http://www.udhc.co.in/INPUT/displayIssueGraphically.jsp?topic_id=826,
as well as here in Bengali-English http://www.udhc.co.in/INPUT/displayIssueGraphically.jsp?topic_id=811
).
Role
of website health professional moderators:
The initial raw data entered by the TCHEs is further structured by the website
health professional moderators toward finding evidence based solutions
(solutions for the previously linked inputs here 1 in English: http://www.udhc.co.in/SOLUTION/viewSolution.jsp?solution_id=94&topic_id=826,
and 1 in Hindi: http://www.udhc.co.in/SOLUTION/viewSolution.jsp?solution_id=95&topic_id=826) 2 in Bengali-English http://www.udhc.co.in/SOLUTION/viewSolution.jsp?topic_id=811&solution_id=96
, http://www.udhc.co.in/SOLUTION/viewSolution.jsp?topic_id=811&solution_id=97
after matching the individual patient
data with general evidence based data.
Collaborative
role of all stakeholders: Both the TCHEs and
online health professional moderators along with the local physician in charge of
the patient would have major contributions to the workflow not just in the initiation
of these patient records to the website but also in maintaining the much needed
informational continuity where all these stakeholders work in online
collaboration toward achieving the best health care outcome for their patient
at hand.
Value
Addition to Hospital Management teams:
1)
Increased inflow of patients seeking health care services from your hospital.
2) Transparent and Informed health care
for patients will mean better health outcomes for patients and better financial
outcomes for your hospital.
3) This is a novel project and perhaps
the need of the hour. This will also provide an opportunity for a training
program in this area and developing a future work force for this form of health
care delivery.
Risks:
1) As this is novel and aims for transparency and better health care outcomes
for people it may upset other stakeholders with different motives.
2) Extreme care shall be required to
nurture patient privacy and at the same time promote transparency.
3) We would have to have a strong and
committed network of health professionals to sustain the high standard of
‘care’ we are promising.
Requirements
to sustain the Project:
Financial investment required for this
from the Hospital management will be minimal.
Current
Status of this project:
Currently this model is being piloted
with a few available volunteers, 2 from West Bengal, 2 from Madhya Pradesh and
being primarily coordinated regularly from Medicine research lab PCMS, Bhopal.
TCHE/E-HealthATM-agent
strategy for each Location:
TCHE
in the hospital: S/he is a hospital employee with a
common-sense interest in patients and is able to type and enter data into the
computer. S/he needs a net book computer along with a data card connection for
which s/he shall be adequately reimbursed (with another Rs 2000/- that will be
added to her/his salary other than the financial incentives for each record…currently
s/he is using the research lab desktop computer and the hospital internet
uploading patient data amidst her other clerical responsibilities).S/he interviews
people with illnesses who present to the hospital, records their history and scans
relevant past investigation records and takes pictures of relevant clinical
findings and radiology and uploads all the relevant individual patient details
(data) onto an online open health record to create individual health records
such as already available here: http://www.udhc.co.in/INPUT/input_directory.jsp
after removing ‘patient identifiers’ to
nurture patient privacy.
TCHE
in the community: Mr/Ms X is a semi
employed man/woman with a current interest in people and health along with a
common sense ability to enter data into the computer S/he has a net book
computer along with a data card connection for which s/he is adequately reimbursed.
S/He runs a E-HealthATM Center from her/his house in a rural/urban community. S/he interviews people with illnesses
who present to her house, records their history and scans relevant past
investigation records and takes pictures of relevant clinical findings and
radiology and uploads all the relevant individual patient details (data) onto
an online open health record to create individual health records such as already
available here: http://www.udhc.co.in/INPUT/input_directory.jsp after removing ‘patient identifiers’ to
nurture patient privacy.
Financial
burden on the Hospital Management: Initial phases
it may come to around 10,000 per month till this strategy gains business
viability. Initial cost of 1 net-book computer for one employee-volunteer in
the medicine research lab would also add up to 20,000/-. Total cost to the
hospital management for the project: 20,000 initial cost and 10,000 recurring
cost till it starts giving returns.
Further desirable incentive for each doctor
in the team: Hospital Management to pay for their data card cost and monthly
internet bill to the tune of 2000/- monthly.
Financial
Returns for the Hospital Management:
1)
Possible revenue from
patients in the community who utilize these Hospital and community integrated E health center services
2)
Improved hospital flow
of patients generating added returns on this small investment.
Ancillary
but Mandatory Requirements from the Hospital Management:
1)
Institutional Ethical
Committee Clearance
2)
Legal expert opinion
3)
Ensuring other faculty
co-operation
Points
for discussion and debate:
1)
Should we charge the
patients for this service by our community volunteer to recover for the resources
spent in generating the online electronic health record for each patient? Is there
any legal or ethical clarifications necessary for this?
