CA2 Generic Review Paper

(Contents Format)

Each section of the format has been mentioned in a separate page.

Title of the review paper: (5 to 15 words)

Survey of the methods of solutions for the

estimation of the number of facilities
required for health services
Author(s)
Name and emails of the contributors (only with their explicit permission/consent)

Name - Surbhi Pal

Email- pals22061@gmail.com
Abstract (100 to ~250 words)

Various public and private sector industries generate, store, and analyze big
data with an aim to improve the services they provide. In the healthcare
industry, various sources for big data include hospital records, medical
records of patients, results of medical examinations, and devices that are a
part of internet of things. Biomedical research also generates a significant
portion of big data relevant to public healthcare. This data requires proper
management and analysis in order to derive meaningful information.
Otherwise, seeking solution by analyzing big data quickly becomes comparable
to finding a needle in the haystack. There are various challenges associated
with each step of handling big data which can only be surpassed by using
high-end computing solutions for big data analysis. That is why, to provide
relevant solutions for improving public health, healthcare providers are
required to be fully equipped with appropriate infrastructure to systematically
generate and analyze big data. An efficient management, analysis, and
interpretation of big data can change the game by opening new avenues for
modern healthcare. That is exactly why various industries, including the
healthcare industry, are taking vigorous steps to convert this potential into
better services and financial advantages. With a strong integration of
biomedical and healthcare data, modern healthcare organizations can possibly
revolutionize the medical therapies and personalized medicine.
 A) Definition/Statement and B) Description/Explanation of the Problem (necessary
and sufficient conditions/statements), and C) Why it is important to solve the
problem (How will society be benefitted from solving the problem) D) Why/How
this project problem/topic can be a good StartUp idea (1 to 3 paras, each para 100
to 250 words)

The definition/statement of the problem is to develop software for

estimation of the number of facilities required for health services.
In real life, healthcare facilities focus on saving patients' lives, so there is no
room for light-mindedness, chaos, or disorganization. Staff activities that
might look “chaotic” at first glance are actually well-organized and
purposeful.
Having a hospital management strategy or top hospital management
software and efficient tools in place is what helps medical professionals
streamline hospital workflows and processes. The most innovative tools
include computer-aided hospital management solutions (HMS, alternatively
called hospital management systems or hospital management software) of
different levels of complexity.
Hospital information management systems exist to identify and alleviate
issues, eliminating some at the root before they can contribute too heavily
to overall costs.
The purpose of a hospital management system is to simplify the processes
of medical workforce planning and facilitate hospital inventory
management. Besides that, it allows healthcare organizations to
● Bring multiple aspects of core clinical processes under one roof
● Integrate and combine medical data flows
● Implement controls for smooth management of healthcare activities
● Allow for enhanced quality of a
● administrative and revenue control
● Achieve superior levels of operational discipline.

This project topic can be a good startup idea as it is believed that the use
of information technology (IT) in healthcare can be a key enabler for
achieving Universal Health Coverage. The use of IT in health was first
advocated at the World Health Assembly (WHA) in 2005. Globally,
information and communication technology (ICT) based health information
systems (HISs) have been developed. These systems capture, store, manage,
analyze and transmit required information related to the health for planning,
decision makings, and resource allocation. Furthermore, ICT can build a
transparent system, and bring accountability and responsibility to people
involved in healthcare service delivery. Hence, this study aimed to
evaluate the HISs that was developed in India for generating information
for surveillance, monitoring, and resource allocation at the PHC level.
The evaluation was done in terms of the effectiveness of a HIS and
challenges during implementation.
Background Theory (1 to 3 paras, each para 100 to 250 words)

A) Terminologies/Concepts used in the field/problem and B) their definitions

The study used a qualitative method to evaluate and understand various

ICT-based HIS implemented at the state/union territory (UT) level in
India. After initial scoping research on HIS through literature search
and observation, in-depth interviews of key informants at various levels
(program managers, analysts, coordinators, data entry operator, and
health care providers) was carried out to have an insight into the user
experience of these systems. An inductive applied thematic coding of
qualitative data was done for analysing the data. Moreover, multiple
applications have been developed under national health programs to
meet health information needs, but at present, there is a limited role of
these HISs in enhancing the effectiveness of comprehensive PHC.
Many of these systems are proprietary-based, and the long-term
sustainability and integration of these systems remain a challenge.
A) Definition/Statements and B) Description/Explanation of the Sub-problems of the
Problem (1 to 3 paras, each para 100 to 250 words)

Storing a large volume of data is one of the primary challenges, but

many organizations are comfortable with data storage on their own
premises. It has several advantages like control over security, access,
and up-time. However, an on-site server network can be expensive to
scale and difficult to maintain. It appears that with decreasing costs and
increasing reliability, cloud-based storage using IT infrastructure is a
better option than most healthcare organizations have opted for.
Organizations must choose cloud partners that understand the
importance of healthcare-specific compliance and security issues.
Additionally, cloud storage offers lower up-front costs, nimble disaster
recovery, and easier expansion. Organizations can also have a hybrid
approach to their data storage programs, which may be the most flexible
and workable approach for providers with varying data access and
storage needs.

Patients produce a huge volume of data that is not easy to capture with
the traditional EHR format, as it is knotty and not easily manageable. It
is too difficult to handle big data especially when it comes without a
perfect data organization for the healthcare providers. A need to codify
all the clinically relevant information surfaced for the purpose of claims,
billing purposes, and clinical analytics. Therefore, medical coding
systems like Current Procedural Terminology (CPT) and International
Classification of Diseases (ICD) code sets were developed to represent
the core clinical concepts. However, these code sets have their own
limitations. There have been many security breaches, hackings, phishing
attacks, and ransomware episodes that data security is a priority for
healthcare organizations. After noticing an array of vulnerabilities, a list
of technical safeguards was developed for protected health information
(PHI). These rules, termed HIPAA Security Rules, help guide
organizations with storing, transmission, authentication protocols, and
controls over access, integrity, and auditing. Common security measures
like using up-to-date anti-virus software, firewalls, encrypting sensitive
data, and multi-factor authentication can save a lot of trouble.
Summary Table of the Subproblems of the Primary Project problem

Serial No Brief Description of the sub-problem (~10 words)

of
Sub-probl
em

1 Storage - Storing a large volume of data is one of the primary

challenges, but many organizations are comfortable with data
storage on their own premises. It has several advantages like
control over security, access, and up-time.

2 Cleaning - The data needs to be cleaned or scrubbed to ensure

accuracy, correctness, consistency, relevancy, and purity after
acquisition.

3 Image pre-processing - Studies have observed various physical

factors that can lead to altered data quality and
misinterpretations from existing medical records.

4 Security - There have been many security breaches, hackings,

phishing attacks, and ransomware episodes that data security is a
priority for healthcare organizations. After noticing an array of
vulnerabilities, a list of technical safeguards was developed for the
protected health information (PHI).

5 Querying - Metadata would make it easier for organizations to

query their data and get some answers. However, in absence of
proper interoperability between datasets the query tools may not
access an entire repository of data.
Classification of the methods in conceptual categories used to solve the problem and its
sub-problems (1 to 2 paras, each para 100 to 250 words)

Methods for big data management and analysis are being continuously
developed especially for real-time data streaming, capture, aggregation,
analytics (using ML and predictive), and visualization solutions that can help
integrate a better utilization of EMRs with the healthcare. For example, the
EHR adoption rate of federally tested and certified EHR programs in the
healthcare sector in the U.S.A. is nearly complete. However, the availability of
hundreds of EHR products certified by the government, each with different
clinical terminologies, technical specifications, and functional capabilities has
led to difficulties in the interoperability and sharing of data. Nonetheless, we
can safely say that the healthcare industry has entered into a ‘post-EMR’
deployment phase. Now, the main objective is to gain actionable insights from
these vast amounts of data collected as EMRs. Here, we discuss some of these
challenges in brief.

The healthcare providers will need to overcome every challenge on this list
and more to develop a big data exchange ecosystem that provides trustworthy,
timely, and meaningful information by connecting all members of the care
continuum. Time, commitment, funding, and communication would be
required before these challenges are overcome.
List of the various Methods used to solve the problem and its sub-problems, and
description of each of the methods, by classification category

Summary Table

Category/ Conceptual Deficiencies in the Reference WebLink

Classification class Keyword-based method (~10 words)
of the Method description of the
method (~10 words)

Health Providing Very often there is a https://www.ncbi.nlm.

Management mismatch in the nih.gov/pmc/articles/
facility-based
Information System
health information HMIS data and it is PMC6881929/
for planning and difficult to rely on
resource allocation upon the available
data for making a
ground assessment
of health conditions
and use it for
resource allocation

Integrated Disease Strengthening of Some of these https://idsp.nic.in/

Surveillance the disease diseases being
Programme surveillance reported on are
system for also reported by
epidemic-prone other systems,
diseases to detect causing ambiguity
and respond to for
outbreaks decision-makers
on what data to
use
Mother and Child To improve It was observed https://digitalindia.gov
Tracking System .in/content/mother-chi
maternal and child that this system ld-tracking-system-m
health services was more focused cts
towards
monitoring of the
health staff rather
than monitoring
maternal and child
health indicators.
This system added
a huge workload
on the health staff,
as they had to
enter name-based
data into the
system and, at the
same time,
aggregate numbers
were also being
entered into the
HMIS portal.
 A) Methods in Classification Category 1, and B) the description (steps) of the these
methods, and C) The quality of solutions obtained from the above methods (with
respect to 1) accuracy, 2) precision/repeatability and 3) time
complexity/quickness/speed of obtaining the solutions (for each of the methods)
(1 to 3 paras, each para 100 to 250 words)

National Health Mission Health Management Information System

(NHM-HMIS) The National HMIS portal was launched in 2008 as a part of
the national reform process. Initially, it was planned as a repository to collect
district-level aggregate integrated reports, but gradually over time, it has gone
right down to the sub-district level, and today around 1,80,000 health
facilities in the country are reporting to this portal. In addition to the
aggregate reports, there is a degree of individual data comprising line lists of
deaths.

The program managers and analysts pointed out that, initially, the portal was
lacking in many basic functionalities, but these have been gradually enhanced
over time. For strengthening analysis, the functionalities were provided to
move the data into proprietary software (SAS software) and the central
monitoring and evaluation department under NHM conducts analysis and
places reports on the portal to be downloaded by the states. Similarly, for
spatial analysis, third-party proprietary software (ArcGIS) is used. The
primary analysis of data is not carried out by the district or facility level staff.
Regarding the utility of HIS data, a respondent stated,

’Very often there is a mismatch in the HMIS data and it is difficult to rely
upon the available data for making a ground assessment of health condition
and use it for resource allocation’
 A) Methods in Classification Category 2, and B) the description of these methods,
and C) The quality of solutions obtained from the above methods (with respect to
1) accuracy, 2) precision/repeatability and 3) time complexity/quickness/speed of
obtaining the solutions (for each of the methods) (1 to 3 paras, each para 100 to
250 words)

Integrated Disease Surveillance Programme The IDSP portal was

launched in November 2004. The portal has facilities for data entry, viewing
of reports, outbreak reporting, data analysis, training modules, and resources
related to disease surveillance. The IDSP portal is under the management of
the National Centre for Disease Control (NCDC), Ministry of Health and
Family Welfare, which is also supported by CDC USA.

In the existing information flow, the health care providers from the most
peripheral unit, i.e. sub-centers and the primary health centers/hospitals, fill
up three sets of forms (S, P, and L–syndromic, presumptive and laboratory
confirmed), and send them manually to the sub-districts/districts where
online entries are done. The L form contains a line list of positive cases,
while the others represent aggregates.

The respondent stated,

‘to get access to their own data, state officials need to request the IDSP office
at national level which often leads to great delays, where time is of the
essence in disease surveillance. Outputs are weak, not supporting strong
responses and actions. Some of these diseases being reported on are also
reported by other systems, causing ambiguity for decision-makers on what
data to use.
 A) Methods in Classification category 3, and B) the description of the these methods,
and C) The quality of solutions obtained from the above methods (with respect to
1) accuracy, 2) precision/repeatability and 3) time complexity/quickness/speed of
obtaining the solutions (for each of the methods) (1 to 3 paras, each para 100 to
250 words)

Mother and Child Tracking System The MCTS system was launched by
the Union Ministry of Health and Family Welfare in 2009, primarily driven
by the logic of improving the veracity of data. It has modules for registering
pregnant mothers and following them for their antenatal care (ANC) visits
and registering children over the immunization cycle.

About the various functionalities in MCTS, a respondent stated,

‘the data is analyzed at central monitoring and evaluation and SMS are sent
to all the states every day on a number of registrations achieved. Initially, the
system was not able to generate follow-up reports or work plans for the
health workers, but gradually over time, this functionality was developed.

The peripheral healthcare providers using the system stated that timeliness
was an issue with the system as there were delays in the registration of data
going up to the national level, where work plans are generated and then sent
back to them. The data entry is made at the primary health center/block level
by a data entry operator, for which auxiliary nurse midwives (ANMs) from
sub-centers have to make a weekly visit to the primary health center/block
office to get their sub-center data entered.

It was observed that this system was more focused on monitoring the health
staff rather than monitoring maternal and child health indicators. This system
added a huge workload on the health staff, as they had to enter name-based
data into the system and, at the same time, aggregate numbers were also
being entered into the HMIS portal. At a later stage, it was realized that a
large portion of reproductive and child health care remains out of the ambit of
this system, therefore, it was decided to switch over to a Reproductive and
Child Health (RCH) portal and close the MCTS.

The health worker using the workplace generated from MCTS stated,

‘The delays in getting the work plans generated from MCTS make them
useless as by the time the work plans are received they already have their due
visits completed’.
Problems/issues still unsolved in the problem and its sub-problems, even after use of all
these methods to solve the problem (1 to 3 paras, each para 100 to 250 words)

Also, summary table of above

Sl. no of Problems/issues still unsolved now in the problem and its sub-problems
Unsolved (~ 10 words per row)
issues/probl
ems still
existing
now

1 There is a mismatch in the HMIS data and it is difficult to rely

upon the available data for making a ground assessment of
health conditions and use it for resource allocation
2 This system added a huge workload on the health staff, as they
had to enter name-based data into the system and, at the same
time, aggregate numbers were also being entered into the
HMIS portal.
3 The application does not offer offline data entry functionalities
which is often a requirement in peripheral areas and remains a
major drawback of the application

SUMMARY

Studies conducted to review the MCTS system have highlighted issues

of the limited utility of data generated through MCTS, as it is only used
for generating the work plan and does not contribute to any health
information reports. The studies on the implementation of MCTS in
peripheral areas have reported challenges related to irregular electricity
supply, inconsistent Internet connectivity, and the slow speed of the
MCTS web portal, leading to delays and time wastage.
The list of gaps/deficiencies/disadvantages in the methods (mentioned above) used for
solving the problem(s) and its sub-problems. (1 to 3 paras, each para 100 to 250 words)

In the HEALTH MANAGEMENT INFORMATION SYSTEM, the disadvantage is

that veryoften there is a mismatch in the HMIS data and it is difficult to
rely upon the available data for making a ground assessment of health
conditions and use it for resource allocation.

In the MOTHER AND CHILD TRACKING SYSTEM, it was observed

that this system was more focused on monitoring the health staff rather than
monitoring maternal and child health indicators. This system added a huge
workload on the health staff, as they had to enter name-based data into the
system and, at the same time, aggregate numbers were also being entered into
the HMIS portal. At a later stage, it was realized that a large portion of
reproductive and child health care remains out of the ambit of this system,
therefore, it was decided to switch over to a Reproductive and Child Health
(RCH) portal and close the MCTS.

In the TUBERCULOSIS CASE TRACKING AND SURVEILLANCE, it

was found that the application does not offer offline data entry functionalities
which is often a requirement in peripheral areas and remain a major
drawback of the application.

At the lowest unit, i.e. the designated microscopy center, data recording is
done manually in registers and the patient card, which is later entered into the
system through data entry operators at the primary health center/block level.
Another limitation of the system stated by the respondent was,

’the application does not support the automatic generation of indicators, and
data needs to be taken out into spreadsheet to generate the indicator
Ideas and conceptual suggestions to overcome these gaps/deficiencies/disadvantages in
the methods (mentioned in point above) (1 to 3 paras, each para 100 to 250 words)

Conceptual suggestions to overcome these disadvantages in the methods are

i. Focus on centralisation: Most systems have focused on central

reporting; thus, they have favoured centralisation.
ii. Limited focus on supporting local action: Typically, the systems
were seen to have limited functionalities on feedback and promotion of
local use.
iii. Systems developed in silos: Most of the systems lack interoperability,
so it is difficult to integrate components of various programs to give a
holistic picture of the patient enrolled in various programs at one point
of care.
iv. Use of proprietary platforms: Many of the large systems (such as
HMIS and SIMS) are based on proprietary systems. While such
software contributes to high costs, they also create vendor lock-ins,
which put at risk the future sustainability of systems.
Conclusion

A) Summary of each para/section in 1 or 2 sentences (merge in total 1 para, 100 to

250 words)

B) Most important contribution of this paper, and future specific work that the
research community should do to get better solutions to the problem. And
Why/How this project problem/topic can be a good StartUp idea (1 para, 100 to 250
words)

Nowadays, various biomedical and healthcare tools such as genomics, mobile

biometric sensors, and smartphone apps generate a big amount of data.
Therefore, it is mandatory for us to know about and assess what can be
achieved using this data. For example, the analysis of such data can provide
further insights in terms of procedural, technical, medical, and other types of
improvements in healthcare. After a review of these healthcare procedures, it
appears that the full potential of patient-specific medical specialty or
personalized medicine is underway. The collective big data analysis of EHRs,
EMRs, and other medical data is continuously helping build a better
prognostic framework. The companies providing services for healthcare
analytics and clinical transformation are indeed contributing toward better
and more effective outcomes. Common goals of these companies include
reducing the cost of analytics, developing effective Clinical Decision Support
(CDS) systems, providing platforms for better treatment strategies, and
identifying and preventing fraud associated with big data. Though, almost all
of them face challenges on federal issues like how private data is handled,
shared, and kept safe. The combined pool of data from healthcare
organizations and biomedical researchers has resulted in a better outlook,
determination, and treatment of various diseases. This has also helped in
building a better and healthier personalized healthcare framework. The
modern healthcare fraternity has realized the potential of big data and
therefore, have implemented big data analytics in healthcare and clinical
practices. Supercomputers to quantum computers are helping in extracting
meaningful information from big data in dramatically reduced time periods.
With high hopes of extracting new and actionable knowledge that can improve
the present status of healthcare services, researchers are plunging into
biomedical big data despite the infrastructure challenges. Clinical trials,
analysis of pharmacy and insurance claims together, and discovery of
biomarkers are a part of a novel and creative way to analyze healthcare big
data.

Big data analytics leverage the gap within structured and unstructured data
sources. The shift to an integrated data environment is a well-known hurdle to
overcome. Interesting enough, the principle of big data heavily relies on the
idea of the more the information, the more insights one can gain from this
information and can make predictions for future events. It is rightfully
projected by various reliable consulting firms and health care companies that
the big data healthcare market is poised to grow at an exponential rate.
However, in a short span we have witnessed a spectrum of analytics currently
in use that have shown significant impacts on the decision making and
performance of healthcare industry. The exponential growth of medical data
from various domains has forced computational experts to design innovative
strategies to analyze and interpret such enormous amount of data within a
given timeframe. The integration of computational systems for signal
processing from both research and practicing medical professionals has
witnessed growth. Thus, developing a detailed model of a human body by
combining physiological data and “-omics” techniques can be the next big
target. This unique idea can enhance our knowledge of disease conditions and
possibly help in the development of novel diagnostic tools. The continuous rise
in available genomic data including inherent hidden errors from experiment
and analytical practices need further attention. However, there are
opportunities in each step of this extensive process to introduce systemic
improvements within the healthcare research.
List of References (Harvard style of citation)

1. https://www.adb.org/sites/default/files/publication/160117/universal-health-coverage-desi
gn-ict.pdf
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6881929/
3. https://journalofbigdata.springeropen.com/articles/10.1186/s40537-019-0217-0
4. https://digitalindia.gov.in/content/mother-child-tracking-system-mcts