The ineffective primary healthcare system is an impediment to cater the healthcare demands in rural areas. An integrated eHealth platform like eLAJ has rarely been used at the primary healthcare level in India to collect information to improve health care processes and outcomes. The PHCs, supposed to provide the first line of defence against any disease in rural areas, is underutilized when secondary and tertiary centres are overburdened. Providing quality of care at the PHC level is crucial to reduce the patient movement by mitigating the burden of diseases at advanced stage. The Government of India has set up Indian Public Health Standards (IPHS) guidelines to help primary healthcare institutions in improving quality of healthcare. Unfortunately, only 14% Sub Centres (SCs) and 21% Primary Health Centres (PHCs) in India are working as per IPHS norms according to Rural Health Survey 2016. A study by USAID claims that only 45% of the public health facilities have ANMs and data entry operators who are trained to capture data on MCTS portal to track MCH indicators. The quality of healthcare services in PHCs and SCs are poor because the protocols and norms to dispense healthcare are not complied. In India, the disease prevalence also varies significantly, so it is crucial to collect sub-district level health information for local healthcare planning and implementation. Meaningful use of EMR/EHR can fill the gap of health information scarcity and medical compliance, and it can boost the competence of healthcare systems. Guidance in optimal use of the system, particularly in the effective use of data made available through electronic medical records, is needed to realize healthcare goals. The major barriers in the adoption of EHR/EMR in India are interoperability standards issues, lack of funds and shortage of suitable governance health policies. Biocon Foundation contributes to provide digital infrastructure for healthcare providers as well as patients. In doing so, the Foundation has initiated the evolution of health information technology in many States of India.
The solution supplements the bigger outpatient primary healthcare delivery system of the government. eLAJ as an eHealth model fits directly into the existing PHC infrastructure of the government with minimal modifications. The project aims to show the proof of concept to catalyse a movement for the adoption of eHealth at PHCs to practice evidence-based medicine. It has set the foundation on which different state governments are building EHR interoperability. 2 years from now, eLAJ should be integrated with various other health schemes and platforms including Telemedicine in order to synergize all the healthcare delivery platforms. Biocon Foundation is rendering support on several fronts to integrate eHealth applications functional in the health ecosystem of government with eLAJ in order to create a unified platform.
The e-healthcare model of ‘eLAJ Smart Clinic’ is an integration of preventive and outpatient primary healthcare services. The primary healthcare approach, early detection and case management, is effective in reducing morbidity and mortality from infectious and non-communicable diseases. It also involves a data driven approach with the help of an in-house Electronic Medical Record (EMR) system which enables our clinics to digitally record the patient encounter. A Multi-Parameter Monitoring (MPM) device records essential vital parameters and can be remotely accessed through a live dashboard. The EMR system helps in maintaining continuum of care, public health surveillance and disease profiles of different communities. It also empowers the decision makers to lead and manage more effectively by providing timely and useful evidence based interventions. The data is also amalgamated with the health delivery model to address the growing need of basic preventive and primary health concerns in the areas of Communicable Diseases, Maternal and Child Health (MCH), Diet-related Non Communicable Diseases (NCDs) and prevention of cancers (Cervical cancer, Breast cancer and Oral cancer) through special health camps. In the interest of fulfillment of proposal prerequisites, the literature will emphasize more on the component of Information and communication technologies (ICT) used in the healthcare delivery hereon.
Health Information System : eLAJ was launched in the year 2015, to harness the potential of Information and Communication Technology (ICT) tools, in order to transform the quality of primary healthcare. The idea behind ‘eLAJ Smart Clinic’ innovation project in the PHCs is to promote adoption of eHealth, health data exchange and interoperability. Under this initiative, Biocon has converted primary health centres into a comprehensive single point treatment facilities to provide systematic clinical consultation and essential diagnostics services. eLAJ Electronic Medical Record (EMR) system maps every patient with a unique identity and it allows to capture, manage and store vital parameters, diagnoses, lab tests, medications and other relevant clinical information on a secure server.
A few of the many standards of eLAJ system are as follows:
• Standardization of ICT tools and implementation specifications to enhance the interoperability, functionality, utility and security of health information
• Patient identifiers including Aadhaar (unique identification of Indian residents) with algorithms to match records
• Clinically valid and reliable architecture and functionality
• Accumulation of medical data of clinically relevant events and encounters
• Immutability to keep the original data intact; provision of editable version with audit trails
• Digital archiving and retrieval of medical records
• Strong security and data encryption to protect personal information from any unauthorized access and tempering
• Ownership of records with service provider on the behalf of the patient
• Disclosure of sensitive information only on patient’s authorization.
There are three interconnected workstations in the eLAJ system which includes Registration, Medical Consultation and Diagnostics:
• Registration : demographic details, addiction profile, past medical history and vital parameters (blood pressure, pulse, blood sugar, weight and pulse oximetry) recorded with the help of Multiple Parameter Monitor (MPM) device and stored at the local server
• Medical Consultation: identification of symptoms, provisional diagnosis, drug prescription, patient follow-up and referrals
• Diagnostics : more than 50 tests including cell count and biochemistry investigations performed at the primary health facility level, which are otherwise not available below secondary care The eLAJ system helps in the integration of workstations, and also commands process and flow of duties between these stations connected through an intranet. The one of its kind highly integrated PHC aid the patient in deriving the best experience from and organised framework of healthcare services. eLAJ is predominantly built using web technologies and the system integration with various devices is done using C++. The registration system, also acts as local server on which all the tools/services and the application are installed, is connected with Multi-parameter patient monitor (MPM620) device and store encrypted data. The doctor and Lab stations (clients) only require a browser to connect to the server system and not store any data. The devices used for eLAJ set up are MPM620, Computers, Biochemistry Analyser, Cell Counter and accessories. Once the data is synchronized to a secure cloud server, various analytics is done through dashboard.
Live Dashboard: The live dashboard is a distinctive feature of the eLAJ system, which organises data on a real time basis and presents at-a-glance as well as minute views of systemic statistical analytics with graphical display. The dashboard allows to monitor facility utilization, quality of care and disease trends. The disease trends also give an insight needed to plan a response in case of any disease outbreak and personalize the treatment for a patient.
• Evidence-based clinical interventions and practices
• Improved overall quality and safety of care
• Improved clinical compliance
• Opportunistic screening
• Targeted health camps
• Optimized personal care
• Continuum of care
• Increased patient participation
• Disease surveillance and outbreak management
Extend : Biocon implemented the eLAJ project at four eLAJ Smart Clinics run exclusively by Biocon Foundation in Karnataka. The model has also been applied at the five Government PHCs in Rajasthan and 15 Government PHCs in Karnataka under Public Private Partnerships (PPPs). The intervention is serving a population of more than 6 lakhs living in rural areas, peri-urban areas and slums.