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.
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?