Five years after the government approved a single, unified project to modernise public health system, the project still remains on paper. Under the national e-governance plan (NeGP), the ministry of health and family welfare had to implement the health mission mode project (MMP). The National Institute of Smart Government (NISG), the consultant for the project since 2012, gave a cost estimate of approximately Rs 8,000 crore.

The project, approved by the government in 2011, focused on five major areas.  First, according to a detailed project report on national health MMP submitted by NISG in 2014, it was aimed at setting up primary health centre (PHC) oriented data collection -- PHC is the first point of contact for the rural population. It provided for data entry facility at PHC level by giving mobile devices to accredited social health activists (ASHAs) and auxiliary nurse midwives (ANMs). Second, it provided for setting up hospital management system, which covered all major departments, in all public hospitals. The electronic health record (EHR) of a patient would be generated at the PHC level. Third, it focused on drug distribution chain – a type of extended inventory management. Fourth, the project provided for creating a central health portal. It would be a one-stop shop for booking appointments and at a later time generate alerts in case of an epidemic, depending on the patient registration data. Fifth, the data generated in the process would help the government in resource planning.

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“The ministry found the cost too high and a final decision is yet to be taken,” said a senior government official. Here are some key interventions made by the NIC:

The first hospital management information system (HMIS) was developed by NIC’s Tripura team in 2009. It was adopted by a few states and was later promoted as a standard application by the ministry for countrywide roll-out. The application, called e-hospital, is aimed at computerisation of the internal management of the hospitals. “It has been developed based on HL7 standard, which is an international standard for integration of hospital functions,” said a senior NIC official working with the ministry of health and family welfare.

The system is based on open source and open standards, the NIC official said. The key modules include patient registration, emergency registration clinics, billing and accounts, path lab, radiology/imaging, blood bank management, In patient department (IPD), OT management, pharmacy management, electronic medical records (EMR) and birth and death registration.

At present, e-hospital is deployed at 50 hospitals across the country, he said. These solutions have been implemented on site – at individual hospitals.

The Delhi-headquartered team of the informatics centre has also hosted e-hospital on government cloud, Meghraj. The cloud hosting reduces expenditure on procurement, installation and maintenance, the NIC official said. The cloud version of the application, however, has only four modules – OPD, IPD, billing and laboratory. In next six months, the informatics centre plans to make all modules available on cloud, he said.

When a hospital registers for cloud, it has to provide master or configuration data. This includes information about the number of beds, details of doctors, schedule, among other things, he said.

Some major hospitals hooked with the cloud application include AIIMS, Ram Manohar Lohia Hospital, Safdarjung sports injury department and NIMHANS, Bengaluru.

The NIC has also implemented an online registration system, ors.gov.in – a public interface of e-hospital. The portal offers appointment, laboratory reports and blood availability.

The NIC also maintains some large databases for the health ministry. Under its mother and child tracking system (MCTS), it has a database of 10 crore women and 8.6 crore children. “Once a pregnant woman has been registered, her visits and medications can be recorded and updated through the cell phone using USSD [Unstructured Supplementary Service Data] system. The system is also used for sending alerts to mothers.

“Now ANMs also test BP, blood sugar and urine of the pregnant woman. All this data is later fed into the system at the public health centre and community health centre levels.”

NIKSHAY, a web-based system to monitor TB, records details of 55 lakh patients. “Under NOTTO [National Organ and Tissue Transplant Organisation], 710 people have pledged online to donate organs after their deaths.”

Another important element in e-health is ‘standards’, which is needed to create electronic health record. The ministry has already finalised meta-data and master code formats.

Every system should follow these standards so that systems can be interoperable, he said.

The ministry plans to integrate all these initiatives onto a common website – a national health portal, nhp.gov.in.

The ministry is also planning to map each and every health facility by giving a unique number – national identification number (NIN). It will be a 10-digit, random number. This will again help in interoperability. All software used in health facilities should contain NIN. Before issuing NIN, the hospitals will be asked about the following: states, district, block, taluka and the type of hospital.

The ministry is also in the process of setting up an electronic national health platform to connect all stakeholders. It will facilitate information exchange between government, private sector and regulators. While the ministry is moving ahead by implementing information and communication technologies in the health sector, the disjointed work poses a challenge for integration and  interoperability, the official said.