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INFORMATION TECHNOLOGY FOR THE HEALTH SECTOR IN NEPAL. Dr Paras K Pokharel Associate Professor Department of Community Medicine BP Koirala Institute of Health Sciences Dharan ,Nepal. HEALTH THREATS. POPULATION EXPLOSION RAVAGING EPIDEMICS NATURAL & SOCIAL CALAMITIES
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INFORMATION TECHNOLOGY FOR THE HEALTH SECTOR IN NEPAL Dr Paras K Pokharel Associate Professor Department of Community Medicine BP Koirala Institute of Health Sciences Dharan ,Nepal
HEALTH THREATS • POPULATION EXPLOSION • RAVAGING EPIDEMICS • NATURAL & SOCIAL CALAMITIES • HIGH LEVEL OF INFANT AND MATERNAL MORTALITY • LOW LEVEL OF LIFE EXPECTANCY • DETERIORATING HEALTH CARE FACILITIES • CRISIS CAUSED BY HIV/AIDS • SPREAD OF MALARIA, TUBERCULOSIS AND OTHER INFECTIOUS DISEASES
PROBLEMS FACED • THESE THREATS PUT PRESSURE ON OUR ECONOMY AND PROMPTED FOCUS ON • INCREASING DEMAND FOR FUNDS FOR HEALTHCARE • TRAINING OF MORE DOCTORS AND PARAMEDICS • CONSTRUCTION OF NEW HEALTH FACILITIES • INVESTING MORE ON HEALTH RESEARCH
PROBLEMS FACED (cont.) • BUT THE SITUATION HAS NOT CHANGED SUBSTANTIALLY OVER THE LAST DECADE RATHER IT IS WORSENING. • WE FACE • DECLINING RESOURCES FOR PUBLIC HEALTH • RAPIDLY EXPANDING MEDICAL KNOWLEDGE • POOR COORDINATION BETWEEN MEDICAL FACILITIES • IN SUCH A SITUATION LET US EXAMINE HOW THE INFORMATION AND COMMUNICATION TECHNOLOGY (ICT) CAN PROVIDE US SOME HELP
HEALTH SECTOR • MOST INFORMATION INTENSIVE • INFORMATION POVERTY: ONE OF THE MOST SERIOUS OBSTACLE FACING HEALTH PROFESSIONALS • ADVANCES IN ICT COULD PROVIDE • FAST • EFFICIENT • CHEAP ACCESS • TO INFORMATION RESULTING IN DRAMATIC IMPROVEMENT IN ACCESS TO ADVICE AND CARE
INFORMATION & COMMUNICATION TECHNOLOGY • NOT LIMITED TO TRANSFER OF INFORMATION • PROMOTE BETTER HEALTH BEHAVIOUR • IMPORVE DECISION MAKING • PROMOTE INFORMATION EXCHANGE AMONGST PEERS • PROMOTE SELF CARE • PROVIDE PROFESSIONAL SUPPORT • ENHANCED EFFECTIVENESS OF HEALTH INSTITUTIONS
ICT APPLICATIONS • ELECTRONIC MEDICAL RECORDS • HOSPITAL INFORMATION SYSTEM • INTRANETS • PUBLIC NETWORKS • HEALTH DECISION SUPPORT • EXPERT SYSTEMS • TELEMEDICINE • COMMUNITY HEALTH • INFORMATION SYSTEM COST * QUALITY * ACCESSIBILITY * DELIVERY
ICT - IMPLEMENTATION • MITIGATE THE SHORTAGE OF HEALTH WORKERS • COMPLEMENT BASIC HEALTH SERVICES • SIGNIFICANT COST REDUCTION BY REPLACING PAPER TO ELECTRONIC MEANS • EFFECTIVE AND TIMELY DELIVERY OF SERVICE • MAXIMISE USE OF SCARE KNOWLEDGE, LIMITED RESOURCE AND FACILITIES • LIFE ENHANCING KNOWLEDGE IN EMERGENCIES • MOST IMPORTANT • ICT : FLEXIBLE : INTERACTIVE : CAN REACH LARGE POPULATION
DISPARITY OF SERVICES URBAN : RURAL • IMPROVING ACCESS TO HEALTH SERVICES IN RURAL AREAS • PUBLIUC EDUCATION CAMPAIGN IN CRITICAL AREAS LIKE AIDS • TRANSFERRING DIAGNOSTIC INFORMATION TO SPECIALISED CENTRES • STRENGTHENING THE BASIS FOR DECISION MAKING • PROMOTE INFORMATION EXCHANGE • REDUCE TRANSPORTATION COST OF PATIENT TO URBAN AREAS
PRIMARY HEALTH CARE • OPTIMAL COMMUNICATION WITH ALL HEALTH CARE SERVICE PROVIDERS • POPULATION BASED DATA COLLECTION : COMMUNITY TO NATIONAL LEVELS • EQUITABLE HEALTH CARE APPROACH • ESTABLISH COMMUNITY HEALTH INFORMATION SYSTEM • DIAGNOSE COMMUNITY HEALTH PROBLEMS • COMBINE LOCAL KNOWLEDGE • TRANSFER KEY DETERMINANTS OF HEALTH
PRIMARY HEALTH CARE(cont.) • STANDARDISATION OF PROCESS • PROMOTE INTERNATIONAL CODING/ INFORMATION EXCHANGE • NETWORKING FOR EPIDEMIOLOGICAL SURVILLANCE • INFORMATION COULD BE PROGRAMMED INTO COMMUNITY RADIOS AND TELECENTRES
EFFECTIVENESS OF HEALTH SERVICES • MANUAL RECORDING PROCEDURES: STATIC IN NATURE • DELAY IN FLOW OF INFORMATION AND DECISION MAKING • CLINICAL INFORMATION SYSTEM • PATIENT RECORDS • BED SIDE DATA • LAB REPORTS • PHARMACEUTICAL RECEIPTS • DEMOGRAPHIC MOVEMENTS BETWEEN HOSPITALS
MEDICAL EDUCATION AND RESEARCH • MORE THAN 360,000 ARTICLES ARE PUBLISHED YEARLY IN MEDICAL JOURNALS WORLDWIDE • TODAY CLINICAL DECISION MAKING : EVIDENCE BASED MEDICINE • PROFESSIONALS NEED : • ACCESS TO WIDE ARRAY OF INFORMATION • APPLY FORMAL RULES OF EVIDENCE TO EVALUATE CLINICAL LITERATURE • TAKE DECISION BASED ON BEST EVIDENCE
ADVANTAGES • ELECTRONIC DATA COLLECTION AND GIS CAN BE DEVELOPED TO MAP SPECIFIC DISEASE IN A GEOGRAPHICAL AREA • MULTIMEDIA APPROACHES CAN STRENGTHEN THE DELIVERY OF PUBLIC HEALTH EDUCATION MESSGES • NETWORKING OF HEALTH PROFESSIONALS CAN ACCELERATE THE INTRODUCTION OF NEW TREATMENT AND PREVENTION METHODS • PATIENT NETWORK CAN BREAK DOWN THE SENSE OF ISOLATION AND STRENGTHEN THEIR PUBLIC VOICE
Nepal Scenario Eastern Region: Bottom Up Planning • HMIS • PUBLIC EALTH OFFICES • HOSPITAL INFORMATION SYSTEMS • LIBRARY • MEDICAL LITERATURE • SURVIEALLANCE & MONITORING • SURVEY FINDINGS
WHAT WE REQUIRE ? • IMPROVE HEALTHCARE MANAGEMENT THROUGH ICT • REQUIRE A CONCERTED EFFORT AT NATIONAL & LOCAL LEVEL • FRAGMENTATION PUT TOGETHER IN PARTNERSHIP • GOVT- NEED TO DEFINE “STANDARDS & LEVEL” • PROVIDE TECHNOLOGICAL INFRASTRUCTURE
MAJOR GAPS • IMPROVE ACCESS TO TELECOMMUNICATION AND COMPUTING INFRASTRUCTURE • INCREASING THE AVAILABILITY OF APPLICATION • EXPANDING COMPUTER LITERACY • IMPROVING CONSUMER DEMAND FOR HEALTH INFORMATION • SURMOUNTING RESISTANCE • DEVELOP STRATEGIES FOR BRIDGING FINANCIAL RESOURCE GAP
NATIONAL HEALTH INFORMATION INFRASTRUCTURE CONSISTS:SET OF TECHNOLOGIES STANDARDS APPLICATIONS SYSTEMS VALUES LAWS GOAL : DELIVER INFORMATION CONSUMERS:PATIENTS: PROFESSIONALS
NATIONAL HEALTH INFORMATION INFRASTRUCTURE HEALTH INFORMATION INFRASTRUCTURE PROVIDER PERSONAL COMMUNITY
STRATEGIES • CREATION OF NATIONAL PUBLIC HEALTH INFORMATICS TASK FORCE GROUP, START FROM EASTERN REGION • IDENTIFYING PRIORITY APPLICATION AREAS • IMPLEMENTATION, EVALUATION AND MONITORING OF PROGRAMS
TASK FORCE • MULTIDISCIPLINARY COMPOSITION • TELECOMMUNICATION : HEALTH PROFESSIONALS : LAWYERS : • INDUSTRY : AWARENESS CAMPAIGNERS • TERMS OF REFERENCE • IDENTIFY NEEDS & DEFINE PRIORITY • ORGANISE THE PUBLIC HEALTH INFORMATICS NETWORK • PREPARE BUDGETS • INITIATE PILOT PROJECTS • ORGANISE AWARENESS WORKSHOPS / SEMINARS • CREATION ONF NATIONAL WEB SITES WITH LINKS TO REGIONAL / GLOBAL HEALTH INFORMATION RESOURCES
HEALTH • NOT MERELY THE ABSENCE OF ILLNESS • NOR IS HEALTH ACHIEVED SOLELY BY COMBATING DISEASE AS W. H. O. PUTS IT • HEALTH IS A “ STATE OF COMPLETE PHYSICAL AND SOCIAL WELL BEING”. • HEALTH IS MORE THAN AN INDIVIDUAL MATTER. • PERSONAL AND COMMUNITY HEALTH ARE CLOSELY CONNECTED AND DEPEND ON INTERWOVEN FACTORS SUCH AS • * POLICIES • * ENVIRONMENT • * HOUSING • * HERIDITY