78 I June 2013

Policies & Regulations: National Health Portal

The National Health Portal (NHP) that was established a few years ago (2010-2011) was set up to put information on

standardisation and protocols in the public domain. The effort was also to ensure that the medical records of the NHP project looked at a long-term view of creating a portal that, in the words of Sam Pitroda, ‘will be a game changer in healthcare.’ As of April 2013, the work continues to be moving at a snails pace and the expected date of launch (August 2013) seems unrealistic.

Reality: When it comes to information on health-related issues1. Information overload confuses the

patient or the information seeker.

2. Lack of credibility of information that is available for India/from India.

3. Inconsistency of information. 4. Literacy rate in India as per 2011 census

is 74.04 per cent. 5. About 30 per cent (330 million) Indians

belong to the poor category, where healthcare affordability and accessibility is a serious cause of concern.

6. Broadband connections at the end of January 2013, according to TRAI, were 15.01 million. Rural wireless subscribers are about 2 million. According to 2011 census, about 20 per cent of urban households and 5 per cent of rural households now own a computer or laptop. About 1 per cent rural India owns a laptop or computer with a net connection.

In terms of information communication mediums, television is far ahead of others.

Then comes print. According to the Deloitte Media Democracy Survey, almost 64 per cent respondents identified television as the primary influencer and about 63 per cent mentioned newspapers as the next influencer. Mobile as a medium ranks third According to TRAI, the tele density has reached 74.24 per cent. However, according to GSMA, taking into account the multiple SIM cards and actual number of active users, there are about 380 million actual users -- about 26 per cent of the total population. Reports are indicating that Indian broadband users are switching to mobile internet. Clearly, mobile will be the game changer for the healthcare industry and the national health portal should be available as an app on all mobile phones Next is Radio. Indian Readership Survey (IRS) report says that, the share of radio listenership on mobile

The National Health Portal (NHP) was ideated in 2010 and in June 2011, the Health Ministry announced that NHP, recommended by the National Knowledge Commission, would make optimum use of technology for establishing a database of medical records of all citizens and other health-related issues. Has this plan lived up to the expectations?

Time for a reality check

Health Portal Home Page

Year 1-4 & Beyond Main Links Sub-Links

Healthy Lifestyle

Healthy Living A-Z List Ayurveda

Unani

Schemes

Siddha

Homeopathy

Interactive Tutorials

Yoga &Naturopathy

Healthcare Provider Locator

User-Specific Information

Careers

E-Learning

NEWS for Healthcare

Professional

National Health Programmes

State Health Programmes

Disaster Management

Forums

News

Forums for Students and Professionals

National Standards

International Standards

Governance & Protocols

Redressal Mechanism

First Aid

Public Health Alerts

Food & Nutrition

Women’s Health

Pregnancy

Child Health

Teen Health

Sexual Health

Healthy Aging

Psychosocial Health

Occupational Health

Travel Health

Health Conditions

AlternativeMedicine

DirectoryServices

RegulatoryIssues MiscellaneousProfessional

Enhancement

National Health Portal

81June 2013 I

phones has increased from 20 per cent in 2009 to about 30 per cent in 2011-12. Future growth in listenership is expected to come from increased penetration of FM radio in smaller cities. According to Prasar Bharati, over 99.19 per cent of the population have access to this cheap medium of communication. Against only six radio stations in 1947, today the number has increased to 326. The All India Radio (AIR) broadcasts program in 23 languages and 146 dialects.

Now, let us relate the above-mentioned realities with the project site map as mentioned in the initial project document. It talks about health content, AYUSH content, regulatory information, disaster management and directory services. (Question: Do we actually need all this?)

Site map If we connect the intent behind the NHP, its objectives and outcomes, the site map and the reality on ground with the need of the hour, following must be taken into consideration:

The NHP is not clear whom it wants to serve? Healthcare professionals, rural population, poor, urban elite etc, or all of them?

What NHP can actually deliver with the above-mentioned complicated site map, which will be extremely difficult to navigate for 95 per cent of the population?

Should NHP be just a web portal for electronic health records and protocols, which are meant for clinicians or educated urban elite, or it should provide clinically validated primary care information and OTC-based treatment and automated electronically guided referrals for the entire population, linking it to the nearest ASHA worker, PHC, Jan Aushadhi stores, hospitals, and diagnostic labs, mapped with geographic information system across the nation?

Primary suggestions1. First and foremost, we need an

introductory video of how to use the NHP, and this video must be not more than a minute. Let us not assume that all the people know how to use Internet (more so, a health website )

2. The NHP needs to be mNHP (Mobile version is a must). A tie up with COAI

& TRAI could help in pre-loading this mNHP app in every mobile phone sold in India.

3. Instead of the complicated site map, which will put off majority of users & fail in its objective, it might be good to consider a simple, intuitive, user friendly and interactive interface. So if I log in from a remote class IV town, using the IP/ network location, the NHP should give me an option of opening a webpage indexed to my town in my local language (so that I could access the local resources that I might need and in the language that I can understand).

4. Next important thing I should be asked (pictorial or audio visual is better), is that whether I am looking for a disease-related information, doctor, diagnosis, medicine (substitute, price, drug interactions, side effects or availability) etc. If I click on disease-related information, I must be guided to something like this in the local language,

If I click on the body part, I should be taken to the ailment and suggestions provided based on an interactive interface. Say, pain in stomach could further prompt, did you take (a) meal outside, (b) consume alcohol, (c) did pain happen before, (d) did you take medicine etc. If someone has taken a medicine, s/he could just feed his contact number which could be automatically forwarded to a national health helpline (local network of ASHA or primary health worker or healthcare service provider) for further consultation or suggest a locally available emergency care or healthcare provider (private or public). Alternatively, a user might like to check for medical information or availability of a particular medicine. Also, the user must be given an option to chose a line of treatment, be it AYUSH or allopathic system. NHP must be able to give the information needed that is actionable. Needless to say, that the clinical information on the website must be something that can be relied upon and not outsourced to organisations that have a conflict of interest.

Points to considerWe must keep in mind that Indians, or for that matter anywhere in the world, we surf the

web either out of curiosity or need, and when it comes to health, it is a need-based search.

Also, we must be clear which segment of the population the NHP wishes to serve? Will it be end users, or doctors, nurses, pharmacists, ASHA workers etc. and, would it be just the tablet wielding urban elite or people residing in the remotest parts of the country, or all of them? If we make it too wide (currently, the project document makes it look vague and intellectual) and the NHP comes up as mentioned in the document, it will be too cluttered and will end up being another government website available. Clearly, the NHP could provide links for healthcare professionals but, as a NHP, it must clearly demarcate its sections without being over crowded. It should also give an option of uploading the health records, which are secure, ensure privacy and ease of use anytime/anywhere. May be, a good idea would be to provide EHR-enabled patient portals, which are interoperable and can be connected to any healthcare providers

Also, it might be a good idea to develop newsletters, health tips and alerts on various health topics and send it periodically to users who opt for them through email or SMS. Also, Facebook, Twitter, Doordarshan and AIR could be used for promoting NHP and keeping the users engaged. Since NHP is being managed by NIHFW, it would be good idea to link government medical colleges and its staff by giving a login ID to individual government doctors for answering the questions on the chat forums, which come from the public via live chats (this could happen at phase II). The chat section needs to be supervised at the NHP HQ. The difference that the NHP can make to the lives of Indians is phenomenal, but one needs to map the needs with the user’s psyche, and fulfill it with advice that is credible, actionable and acceptable.

(office@rajendragupta.in)

Rajendra Pratap Gupta International Healthcare Expert, President, DMAI