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National eHealth Authority alone cannot help

On Sunday, May 10, the ministry of health and family welfare, government of India, closed the window for receiving public opinion on its concept note on National eHealth Authority or NeHA, as it is being referred to.

twitter-logo E Kumar Sharma        Last Updated: May 15, 2015  | 10:52 IST

E Kumar Sharma, associate editor, Business Today
On Sunday, May 10, the ministry of health and family welfare, government of India, closed the window for receiving public opinion on its concept note on National eHealth Authority or NeHA, as it is being referred to.

It is to be a nodal authority that will be responsible for development of an Integrated Health Information System (including Telemedicine and mHealth) in India, while collaborating with all the stakeholders - healthcare providers, consumers, healthcare technology industries, and policymakers. It will also be responsible for enforcing the laws and regulations relating to the privacy and security of patients' health information and records.

Few can argue against the need for this. In fact, it is a good beginning as many experts have often argued in favour of having some form of regulations and systems in place in areas like telemedicine, which very loosely is really doctor consulting over telephone or over the internet with the patient sitting miles away from the doctor.

Yet, questions remain on how good an integrated health information system will be in a scenario where there is either lack of data or where there are huge gaps in data. And to top it all, the ability or the lack of it to manage data confidentiality and the standardisation so that it can be moved from one hospital to another.

Healthcare experts have always maintained that integrated information and better managed health information is critical as a doctor seeing a patient should have access to previous information about the patient, not just to avoid repetition of tests but also to ensure better diagnosis and treatment.

But the challenges are not small. For instance, Dr K. Srinath Reddy, President of the Public Health Foundation of India (PHFI) and former head of the Department of Cardiology at All India Institute of Medical Sciences (AIIMS), while welcoming the need for this, points to our preparedness with respect to our field level data gathering and information systems that don't seem to work properly. "You don't know how many cases of malaria are there. You do not have a real time data collection and data analysis. Many of our surveys are conducted once in five years. Those are some of the challenges where health information systems need to be first better managed by technology-enabled frontline health workers contributing to lot of field level data," he says.

As is apparent, unless these weaknesses are removed, just integrating the data may not help as there are going to be huge data gaps. It is not as if data cannot be easily collected and authenticated. The microfinance industry has shown that there are enough mobile phones and tablets to be able to gather data and transmit it real time. In fact, it is often argued that with technology it should be possible to move towards a stage where one is able to predict epidemics.

The upshot therefore is to first focus on enough data and authentic data, even if not real time. Given the way the country has had to deal with seasonal diseases, health surveys need to be done not at intervals of five years but more frequently - ideally every six months.

Much now depends on what the government does with the feedback on the concept note.  Will this be used as a platform for consultation? Is the government open to revision of the proposal, based on the feedback?

A look into the gaps in the data gathering systems and strengthening them would have been a better starting point. The government had earlier also sought public opinion on its draft national health policy 2015 but nothing much is heard on that now. Hope this move on NeHA is taken forward and all the associated issues around it looked into by the government.

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