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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

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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

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PROBLEMS FACEDTHESE 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

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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

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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

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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

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ICT APPLICATIONS

COST * QUALITY * ACCESSIBILITY * DELIVERY

• ELECTRONIC MEDICAL RECORDS

• HOSPITAL INFORMATION SYSTEM

• INTRANETS

• PUBLIC NETWORKS

• HEALTH DECISION SUPPORT

• EXPERT SYSTEMS

• TELEMEDICINE

• COMMUNITY HEALTH

• INFORMATION SYSTEM

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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

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DISPARITY OF SERVICESURBAN : 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

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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

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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

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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

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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

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• 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

ADVANTAGES

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• HMIS

• PUBLIC EALTH OFFICES

• HOSPITAL INFORMATION SYSTEMS

• LIBRARY

• MEDICAL LITERATURE

• SURVIEALLANCE & MONITORING

• SURVEY FINDINGS

Nepal Scenario Eastern Region:Bottom Up Planning

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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

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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

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CONSISTS : SET OF TECHNOLOGIES

STANDARDS

APPLICATIONS

SYSTEMS

VALUES

LAWS

GOAL : DELIVER INFORMATION

CONSUMERS:PATIENTS:

PROFESSIONALS

NATIONAL HEALTH INFORMATION INFRASTRUCTURE

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NATIONAL HEALTH INFORMATION INFRASTRUCTURE

PROVIDERPERSONAL

COMMUNITY

HEALTH INFORMATION INFRASTRUCTURE

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STRATEGIES

• CREATION OF NATIONAL PUBLIC

HEALTH INFORMATICS TASK FORCE

GROUP, START FROM EASTERN REGION

• IDENTIFYING PRIORITY APPLICATION

AREAS

• IMPLEMENTATION, EVALUATION AND

MONITORING OF PROGRAMS

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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

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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

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