INFORMATION TECHNOLOGY

INTRODUCTION
In today’s world of digital era, no sector has been left untouched with the involvement of
technology, the same stands true for health care sector. With the revolution of internet, the
transfer of information in the form of data from an end-user to planner’s covering limitless
boundaries via Internet in fraction of time. Keeping abreast the technology & health gives us an
ample opportunity to address the community health at large.

DEFINITION
Information Technology (IT) can be defined as –
“ The study or use of systems (especially computers & tele communications) for storing,
retrieving & sending information.”

Simply stating it is the utilization of electronic media for storing digital information that can be
easily retrieved from its stored format at the time of transmission intended for ease in its
communication & rapidly in its utilization.

USES
 Use of IT in health has facilitated in reducing the cost borne by the families, the
accessibility & services for their health care have been improved.
 Appropriate use of e-health initiatives has enabled in addressing all the components of
universal health care, thus achieving health goals in terms of accessibility, high quality,
affordability at individual level, reduction in disease burden & effective monitoring.

MOBILE HEALTH
m-health (mobile health) further expand the vision of Universal Health Coverage (UHC) to
address the vastly undeserved healthcare needs when combined with current ongoing mobile
phone reach in undeserved areas & rapidly growing smart phone adoption.

Moreover global use of e-health initiatives is making a remarkable impact & enabling the
community to have an option to get health care available to them in any part of the world round
the clock by using internet-based voice, data, & services.

DIGITAL INDIA CAMPAIGN

The concept of use of IT health in community health care (CHC) has been strengthened with the
launch of Digital India Campaign by the GOI on 1 st July 2015 so as to ensure the government
services in different sectors made available to citizens digitally or electronically by enhancing
existing infrastructure & by increasing Internet connectivity to all areas of the country. Thus
making the India digitally & technologically empowered.

“Community Health” is “a multisector & multidisciplinary collaborative enterprise that uses

public health science, evidence-based strategies, & other approaches to engage & work with
communities, in a culturally appropriate manner, to optimize the health & quality of life of all
persons who live, work, or are otherwise active in a defined community or communities.”

Succinctly, electronic media plays vital role in managing health care of human populations living
in different communities. In the modern digitized world, the relevance of this topic is self-
explanatory to medical undergraduates who cannot think of separating themselves from their
smart-devices even during daily activities of living like toileting, mouth care, bathing, dressing,
grooming, & eating.

In regards to CHC in India, the proposed & potential marriage of “Digital India” program &
“Ayushman Bharat” program for the success of both programs warrants that CHC professionals

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irrespective of their stage in professional career must understand, imbibe & endorse “Use of IT
in CHC can be elaborated on the following subtopics :
 e-Health & m-Health : concepts & scope
 telemedicine & community health
 health care: health education, training, monitoring, epidemic forecasting
 electronic health records
 Health management information system (HMIS)
 RMNCH+A (Reproductive, Maternal, Newborn, Child & Adolescent Health)
 CMIS/SMIS (Computerized Management Information System/Strategic
Information Management System) in NACP (National AIDS Control Program)
 Reporting in integrated disease surveillance program
 Mother & child tracking system (MCTS)
 99DOTS and Nikshay in RNTCP (Revised National Tuberculosis Control Program)

e-HEALTH AND m-HEALTH

Gunther Eysenbach (2001) defined e-Health as – “an emerging field in the intersection of
medical informatics, public health & business, referring to health services & information
delivered or enhanced through the Internet & related technologies” & “not only a technical
development, but also a state-of-mind, a way of thinking, an attitude, & commitment for
networked, global thinking, to improve healthcare locally, regionally, & worldwide by using
information & communication technology.”

As per World Health Organization(WHO) 2011, m-Health is defined “m-Health or mobile health”
being “component of e-Health” as-
“medical & public health practice supported by mobile devices, such as mobile phones, patient
monitoring devices, personal digital assistants (PDA) & other wireless devices” with “ use &
capitalization on a mobile phone’s core utility of voice & short messaging service (SMS) as well
as more complex functionalities & applications including general packet radio service (GPRS),
3rd & 4th generation mobile telecommunications (3G and 4G systems), global positioning system
(GPS), & Bluetooth technology.”

In term of concepts & scope of e-Health & m-health for CHC, the definitions are self-
explanatory. Simply stating, whenever electronic media is being used to develop, document &
communicate for the sake of achieving, ensuring, bettering CHC, it is e-Health; & whenever
smart devices are further enhancing this opportunity to besting CHC by on-the-go mobility, it is
m-Health.

When decoding “10 e’s in e-Health (Efficiency, Enhancing, Evidence-based, Empowerment,

Encouragement, Education, Enabling, Extending, Ethics, and Equity) as documented by Gunther
Eysenbach (2001), e-Health envisages -
 Efficient
 Qualitative
 Proven
 Empowered
 Relatable
 Educational
 Expansive
 Ethical &
 Equitable CHC.

To name a few among scores of e-Health initiatives from National Health Portal, the self-
explanatorily named e-Health initiatives are-
 Rashtriya Bal Swasthya Karyakram
 e-Aushadhi

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  Chirayu
Similarly, to name a few among almost nearing a hundred of m-Health initiatives (websites &
apps) from National Health Portal, the mobile apps with self-explanatory names are –
 Safe pregnancy & birth
 Mobile family planning tool: CycleTel
 TB Detect
 Malaria Early Epidemic Detection System (MEEDS)
 Cardiopulmonary Resuscitation (CPR)
 NewBorn Care
 HealthPhone Poshan-Nutrition

Initiatives in e-Health & m-Health

1. VITAL EVENTS

a. Vital registration : vital statistics at a community level related to data regarding live births,
deaths, marriages, etc. The most common way of collecting information on these is through civil
registration & later data entry is being done to convert it into electronic form by entering in
computer, by the use of IT we can capture the real time data from the set location.

b. Birth & Death entry application system : this system is being used in Gujrat to capture &
monitor statistical data of birth, death & still birth. It has a capability to analyse the
demographic & personal information that has been stored in the system. The main aim is to
maintain database of birth & death records.

c. E-Olakh : this is another example of effective use of information & communication technology
(ICT) that is client oriented & has been developed for birth, death, stillbirth records. It not only
maintains real time database of vital registration but also facilitates issuing of birth & death
certificate.

2. MATERNAL & CHILD HEALTH

a. Maternal child tracking system (MCTS) : this has been developed by Government of India & is
being used Pan India under NRHM (National Rural Health Mission) web portal. The aim is to
tackle the issue of maternal deaths that could be prevented if by addressing the issues of
healthcare accessibility during antenatal, intrapartum & postpartum period.

b. e-Mamta (MCTS) : It is an active interactive provider cum beneficiary-oriented name-based

registration platform, that accounts for tracking of every pregnant woman & children that gives
village level work plan to the health care provider & SMS to the beneficiary.

3. CHILD HEALTH – RASHTRIYA BAL SWASTHYA KARYAKRAM (RBSK)

Chirayu : under RBSK the early identification & early intervention for children from birth to 18
years to cover 4 “D”s viz. defects at birth, deficiencies, diseases, development delays including
disability is screening by healthcare providers. This program has been enabled through a cold-
based, tablet PC system, providing dashboard-based reports for various levels of administrators
or doctors at all levels.

TELEMEDICINE & COMMUNITY HEALTH

Telemedicine has reduced geographical barriers like difficult to reach hilly terrains, deserts,
underdeveloped rural & tribal areas by reducing the cost & providing accessible , affordable

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care where people gain not only economically as well as in terms of time & travel for speciality
care services. World Health Organization (1998, 2010) defined telemedicine as –
“ the delivery of healthcare services, where distance is a critical factor, by all
healthcare professionals using information & communication technologies for
the exchange of valid information for diagnosis, treatment, & prevention of
disease & injuries, research & evaluation, & for the continuing education of
healthcare providers, all in the interest of advancing the health of individuals
& their communities.”

Telemedicine is able to provide safe, timely, cost-effective, & qualitative health care to even
individual patients in spite of their physicians being located far away from them in very remote
locations. Therefore, it is a no-brainer that telemedicine can & will guide CHC for managing,
documenting, monitoring & educating communities’ health care including prevention of their
diseases & health promotion activities among them with early recognition & management of
epidemics & pandemics. The modern world is a globalized one wherein telemedicine can
overcome geographical & corresponding economic barriers as far as the availability of
educational, awareness, communication, & referral resources to one-and-all through “safe-and-
protected internet” but only after the community leaders, their local managers & on-site care-
delivery equipments may have been arranged with the resources from among the communities
being served. To name a few from National Health Portal, the telemedicine initiatives in India
are “e-Hospitals”, “National Health Helpline” & “National Telemedicine Network (NTN).”

HEALTH CARE: HEALTH EDUCATION,TRAINING, MONITORING,AND EPIDEMIC

FORECASTING
Information technology is also playing vital role in health care, health education, training,
monitoring & epidemic forecasting. World Health Organization states health education in CHC
being
“any combination of learning experiences designed to help individuals &
communities improve their health, by increasing their knowledge or influencing
their attitudes” and training in health care is an essential part of “knowledge transfer&
training for outbreaks.”

World Health Organization annually document “World Health Statistics Series” as quantification
of global health’s status as per monitored “Sustainable development goals’ as defined, refined 7
revised from time to time.

Epidemic forecasting in CHC World Health Organization is all for ‘’anticipating epidemics” on
the line of anticipating disasters & weathers by calling out for collaboration among closely
related multifaceted fields so that epidemic forecasting does not remain in the state of infancy
any longer than it has already been.

Myres et al. (2000) called for forecasting as an essentiality for preparedness against disease &
Shawn Dolley (2018) reiterated the essential role of “Big Data” for delivering CHC with astute
precision. Not only for forecasting for bettering care delivery during CHC, IT is becoming & will
definitely be indispensable for CHC education & training programs & IT-based monitoring of
CHC programs. Without question, the budding & aging physicians must or will have to imbibe
the core user-friendly concepts of IT if they will want to survive as a deliverer of modern CHC
that is slowly & surely becoming dependent on the evolving systems of IT-based healthcare

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education, training, monitoring & forecasting. The sooner the physicians’ community realizes
the essentiality for “being digitally literate” & “being IT literate”, the sooner they will break their
barrier to sustain & grow in fast-evolving digitalized & globalized world irrespective of whether
they are limited to just delivering CHC or overall healthcare-in-too.

ELECTRONIC HEALTH RECORDS

Electronic medical records (EMR) are “everything” contained within “a paper Chart, such as
medical history, diagnoses, medications, immunization dates, allergies” but their utility is
“limited because they do not easily travel outside the practice” and may “even have to be
printed out & mailed for another provider to see it”.

Comparatively, as per practice fusion, Electronic Health Records (EHR) “are digital records of
health information” & “contain all” that is there in EMR “- and a lot more” such as “past medical
history, vital signs, progress notes, diagnoses, medications, immunization dates, allergies,
laboratory data & imaging reports” and additional information like “insurance information,
demographic data, & even data imported from personal wellness devices” which are “instantly
accessible to authorized providers across practices & health organizations, helping to inform
clinical decisions & coordinating care” among “all clinicians & organizations involved in a
patient’s care such as laboratories, specialists, imaging facilities, pharmacies, emergency
facilities, & school & workplace clinics”.

Considering the requirements for transparency, accountability, & continuity of patient care,
they are morally, ethically, & legally essential for all health care including CHC. Therefore, it can
never be stressed enough that HER must be part & parcel of all modern CHC to ensure fast,
smooth, affordable, & accessible CHC to all components of the community. HER being IT-based
modality also create banks of extractable data to audit the delivered CHC thus self-reflecting on
its efficacy
To recognize if there is any further need to innovate when trying to remain up-to-date as well as
closing the gaps if any in the currently delivered CHC.

HEALTH MANAGEMENT INFORMATION SYSTEM : RMNCH+A & CMIS/SIMS IN NACP

World Health Organization (1993,2004) defined HMIS as –
“ as information system specially designed to assist in the management &
planning of health programs, as opposed to delivery care”.
Under “Digital India” initiative, “Health Statistics Information Portal” and online “Health
Management Information System interference” play the above-mentioned role.

As per Ministry of Health & Family Welfare, Government of India (2013), RMNCH+A is “a
strategic approach to reproductive, maternal, newborn, child & adolescent health in India”
which includes role of HMIS for “tracking of stocks” of medicine, for “monitoring & review” of
RMNCH+A “to strengthen this system & improve the quality of data” & “improve decision
making” via “HMIS-based dashboard monitoring system”.

Per National Aids Control Organization, the National AIDS Control Organization, the “National
Aids Control Programme Phase III (2007-2012)” had initially depended on “CMIS, an offline
Computerized Management Information System (CMIS) introduced in 2002 to capture &
maintain the database of HIV/AIDS control program across the country” to eventually integrate
with “SMIS Strategic Information Management System (SMIS), an integrated web based
reporting & data management system launched in 2008 to replace CMIS” with “real time data
entry & access to the user” via “online Data Item Report” for “analysis & evidence-based action,
timely corrective measures for program managers & policy makers which help in monitoring at
the grass root level”.

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The above mentioned quotes directly from original sources are self-explanatory that without
IT- based HMIS, the quality of delivered CHC can be neither quantified transparently nor
corrected timely to effectively manage the quantity of delivered CHC whether it is for
reproductive health or maternal health or newborn health or child health or adolescent health
or AIDS control with in communities.

REPORTING INTEGRATED DISEASE SURVEILLANCE PROGRAM

Integrated Disease Surveillance Program (IDSP) initiated in 2004 by Ministry of Health &
Family Welfare with objective “to strengthen decentralized laboratory-based IT-enabled disease
surveillance system for epidemic prone diseases to monitor disease trends & to detect &
respond to outbreaks in early rising phase through Rapid Response Team” through Integration
& decentralization of surveillance activities through establishment of surveillance units at
Center, State, & district Level,” “Human Resource Development- Training of State Surveillance
Officers, District Surveillance Officers, Rapid Response Team & other medical & paramedical
staff on principles of disease surveillance”, “Use of Information Communication Technology for
collection, collation, compilation, analysis, & dissemination of data”, “Strengthening of public
health laboratories”, & “Intersectoral co-ordination for zoonotic disease”.

Especially, IDSP cannot function without IT-based interfaces if it wants to first decentralize so
as to monitor the needs for as well as the adequacy of CHC delivery as remotest independent
units of communities before thereafter integrating its data of independent units to guide the
future CHC delivery based on its learning of common as well as unique needs of independent
units of communities whose surveillance data are being integrated under IDSP.

MOTHER AND CHILD TRACKING SYSTEM

As per Ministry of Health & Family Welfare, Mother & Child Tracking System is “an innovative,
web-based application” utilizing “information technology for ensuring delivery of full spectrum
of health care & immunization services to pregnant women & child up to 5 years of age” so as
“to facilitate & monitor service delivery as well as to establish two way communication between
the service providers & beneficiaries”.

At the core of all communities formed of human populations is “mother and child”, and if their
health and welfare is not tracked, it destabilizes the core of communities formed of human
populations wherein the future of such communities becomes bleaker to no future at all.

Without IT-based communication system, this tracking cannot be envisaged in timely, accessible
and attainable fashion to make any immediate and long-term impact on “mother & child” and
their communities being served with delivered CHC.

99DOTS AND NIKSHAY IN RNTCP

Central Tuberculosis Division Ministry of Health and Family Welfare, adopted strategies to
strengthen RNTCP by envisaging National Strategic Plan for Tuberculosis Elimination 2017-
2025.

99DOTS is innovative Directly Observed Treatment, short-course strategy for reaching to 99%
tuberculosis patients as “a low-cost approach for monitoring and improving TB medicine
adherence” wherein “each anti-TB blister pack is wrapped in a custom envelop, which includes
hidden phone numbers that are visible only when doses are dispensed” & thereafter “patients
make a free call to the hidden phone number, yielding high confidence that the dose was “in-

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hand & has been taken” because enrolees “receive a series of daily reminders (via SMS &
automated calls)’’ and “missed doses trigger SMS notification to care providers, who follow up
with personal, phone-based counselling”.

Recently 99DOTS integrated with Nikshay that is “a web-enabled & case-based monitoring
application” so as to ensure “monitoring of TB patients” when “ used by health functionaries at
various levels across the country” wherein it “covers various aspects of controlling TB using
technological innovations” using “SMS services” along with “web-based technology” ensuring
“communication with patients & monitoring the program on day to day basis”.

In a nutshell, TB being major communicable diseases disabling Indian population eats into
major economic resources allocated by GOI for health care. Vision for eliminating TB by
strategically planning during 2017-2025 cannot be realized without IT-based monitoring of TB
patients receiving DOTS that in turn is aiming to prevent development of multidrug resistant TB
strains because development of multidrug resistant TB strains will surely push the time frame
for eliminating TB much beyond the year 2025.

LIMITATIONS

In context of potential scope of IT in underexplored areas of health care, it is difficult to imagine

future health care without IT support. In future itself, only the application will vary but health
care will not be delivered without IT-based interfaces and applications except for “tender loving
care (TLC) which will always need humans’ humane touch.

Certain limitations cannot be overlooked with the use of technologies like for implementation of
technologies availability of trained manpower is essential. Technical constraints, including
connectivity & , bandwidth provision, and reliability, also need to be taken care of along with
availability of health professionals for correct diagnosis and treatment.

Cost consideration and affordability need to be taken into account for the development and
implementation of national plan for e-Health along with its integration into the health system.
People residing in rural & remote areas need to be made aware of the existence of such e-
Services in their areas; their ethical & social issues also need to be addressed.

As far as problems of IT encroaching our healthcare including CHC, the major immediate
problem is the safety of data & privacy leading to dangerous outcomes. Essentiality of education
& training of modern CHC providers & professionals in protecting the data & ensuring the
confidentiality will go a long way to achieving the sanctity of data’s oceans which can then safely
ensures governance of communities’ health care without putting their privacy at risk.

There is no escaping “Use of IT in CHC” just like human existence seeming impossible without
smart devices today & it is better to surrender to the flow of time & imbibe IT in CHC before the
time changes again for better or worse depending on the change in our needs & the tools we will
need to deal with them as the future of human existence unfolds.

CONCLUSION

REFERENCES
Kadri AM. IAPSM’s Textbook of Community Medicine. 1st edition. New Delhi: Jaypee Brothers
Medical Publishers; 2019.P- 1187-1191

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