One in every four Indians risks dying of a non-communicable disease (NCD) before they reach the age of 70. Today, nearly 10 percent of the population in the country above 18 has diabetes. That number increases drastically when it comes to hypertension, and 25 percent of people in the same demographic suffer from the condition. The numbers are similar for other types of NCDs, including cardiovascular diseases, cancer and chronic respiratory diseases. Nearly 60 percent of all deaths in India are due to NCDs.
This is no longer just a healthcare problem alone, but a larger developmental challenge. NCDs also adversely impact the productivity of the working population and take a toll on the economic well-being of people due to rising healthcare costs.
India became one of the first countries to respond to these challenges and set specific targets to bring down the burden of mortality due to NCDs by 25 percent by the year 2025. In 2017, the Union Government launched the National Multisectoral Action Plan for prevention and control of NCDs. Developed by the Ministry of Health and Family Welfare, the Action Plan states that the aim should be prevention and improved management of NCDs, with screening, early diagnosis, and sustained management of those with or at high risk for major NCDs. The plan advocates active engagement of different stakeholders – Union and state governments, private sector, civil society, academia and others.
But this was a challenge in rural India, where there was low awareness about NCDs.
A digital solution designed for healthcare challenges in rural India
The 200,000-strong network of auxiliary nurse midwives (ANMs) supported by the almost million-strong village level ASHA workers have been the first point of contact for healthcare in rural India – be it providing villagers with information about managing tuberculosis or assisting during childbirth. So it was only practical for them to play a key role in the fight against NCDs. But there was a challenge; traditionally ANMs relied on a paper-based system for recording services provided and that system had ballooned into 50+ paper registers consuming sometimes a couple of hours a day for reporting. For NCDs, which are chronic conditions, patients need to adhere to a strict regimen of treatment and follow-ups for life. ANMs clearly needed help in screening, referring and tracking NCD patients who often fell through the cracks, missing follow-ups or discontinuing their treatment midway.
Recognizing this challenge and armed with a strong understanding of the situation coupled with powerful technology, Dell teamed up with Tata Trusts to design and implement Digital LifeCare Solution for the Non-Communicable Diseases national program under Ayushman Bharat scheme initiated by Government of India. The platform has been designed to meet the needs of health workers and doctors in primary, secondary and tertiary-level government facilities as well as health officials responsible for implementing the program.
The Digital LifeCare platform includes mobile and web apps with dashboards built on a highly scalable, secure, robust, modular, open-API platform. Digital LifeCare guides the doctors and offers recommended actions and alternatives at each step through protocols that ensure patients receive the same level of care, each time.
The mobile app features a series of interactive modules to lead the users, includes prompts to obtain family and medical history, and a referral module to refer the patient to the appropriate level for further investigations or treatment.
Given that NCDs are silent, chronic diseases that need constant follow-ups, there is a comprehensive planning tool that allows ANMs and doctors to track patients’ follow-up visits and focus on those who have fallen through the cracks. The health record with a unique health ID for each individual is created on the cloud and updated during every doctor visit. The platform also includes a web portal for doctors and dashboards for health officials to spot trends across India. The portal is based on the Government of India’s disease protocols for examination, referral, diagnosis, treatment and follow-up.
All this ensures that Digital LifeCare, officially released in April 2018, enables the twin goals of continuum of care for citizens across facilities, and seamless, secure data-sharing for a unified view of the patient.
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A collaborative effort to ensure more meaningful outcomes
Digital LifeCare was developed by Dell, through Dell Giving, a CSR initiative, and in collaboration with experts from National Health Systems Resource Center (NHSRC), All India Institute of Medical Sciences (AIIMS), the Directorate General of Health Services (DGHS), World Health Organization (WHO) India, the Indian Council for Medical Research (ICMR), National Institute of Cancer Prevention Research (NICPR). Tata Trusts, as program implementation partner for Digital LifeCare is supporting the Government in the deployment and training of users. Technical inputs were provided by experts at National Informatics Center (NIC), Center for Health Informatics (CHI), the India Stack team at iSPIRT, Harvard and various State Health Departments.
Today, a year after the national launch, Dell, as the technology partner, continues to work closely with the Ministry of Health and Family Welfare to further improve the solution. In addition to feedback from the Ministry and experts, user feedback is also being incorporated. For instance, given that rural patients may visit any health facility based on their convenience, the referral system was made flexible to accommodate this.
The solution is being adopted widely across the country. And helping the government in the planning and implementation effort has been Tata Trusts, through training, and programme management. “Our trained and skilled personnel on the field provide health workers, doctors and local administrators ready access to support and guidance on challenges they may face,” explains HSD Srinivas; Director Health, Tata Trusts
A journey that began five years ago
Digital LifeCare was seeded in the Dell Technologies India Centre of Excellence (COE) in 2014, with an aim to leverage Dell’s technology stack and solve a national problem with key stakeholders such as the government.
Tracing the journey of Digital LifeCare from its early days as a pilot to a national-level healthcare solution, Sunita Nadhamuni, Head, Healthcare Solutions shares, “The idea of a comprehensive digital solution to empower primary healthworkers was conceptualized by us with the non-profit Karuna Trust. In 2016, Dell worked with the health department of Andhra Pradesh on an ambitious, progressive scheme to screen a target of 7 million women above 35 for non-communicable diseases like cancer, diabetes, heart and respiratory ailments. The platform was used by 7,000 health workers in a span of six months. By 2017, Telangana became the third state to adopt this solution in 8 districts. Towards the end of the same year, Dell began working closely with the Ministry of Health and Family Welfare as its technology partner to build and customise Digital LifeCare as we know it today.”
Sunita’s team from Dell designed and managed Digital LifeCare and continues to be closely involved as India continues its fight against NCDs.
Since its inception in 2014 until today, 20,000+ health workers and doctors have been trained, the software has been rolled out in more than 20 states in India with 24 million people enrolled in the system. Through this journey, the Digital LifeCare platform has evolved to become a recognised healthcare technology solution specifically for managing NCDs in India.
Digital LifeCare is just one example of how Dell brings to life its mission to create technologies that drive human progress.
“The best way we can give back to society is by doing something that you are best at. Dell lives and breathes technology; hence it is only fitting that we take up this job. Social impact is not a tick mark activity for us, but something that we are passionate about,” says Vinita Gera, Senior Director and General Manager, India COE, Dell Technologies.
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