On August 2, 2017, the Himachal Pradesh government in India announced the launch of the E-Health Card for citizens of the state, which was the first of its kind in Southeast Asia. And as of December 2018, the federal government is currently looking into integrating unique features from both the E-Health Card and the MIS into a national MIS for NCDs for continuous active and passive disease surveillance in the country.
The HealthCard was originally proposed by the Government of Himachal Pradesh and implemented by the HealthRise India team, with active support from GHL Fellow Dr. Nayanjeet Chaudhury. Dr. Chaudhury, who is the Medtronic Foundation’s technical adviser in India, worked with the HealthRise India team to develop and deploy the HealthCard across the entire state to collect information about risk factors for several non-communicable diseases from 3 million adult citizens in the state. HealthRise India is a flagship program of Medtronic Foundation, and conducted locally in Shimla by MAMTA Health Institute for Mother & Child and in Udaipur by Catholic Health Association of India.
The HealthCard project is part of the Himachal Pradesh government’s larger mission to improve access to primary care and prevent and control NCDs in the state. So far, over 350,000 adults have been enrolled into the HealthCard by the state government. The E-Health Card was selected for the Prime Minister’s Award for Excellence and featured in the book “New Pathways: Stories of Innovations and New Initiatives in Implementation of Priority Programmes” in April 2018.
How the E-Health Card works
The E-Health Card is a digital tool embedded in a smartphone or tablet to assist providers during the care process. Using this tool, public sector frontline health workers (also known as ASHAs) collect data at the primary care level and are able to actively survey prevalence and risk factors of non-communicable diseases (NCDs) in the population. This helps healthcare officials to estimate local disease burden more accurately and inform appropriate plans of action. The E-Health Card also assists ASHAs in following up with patients for diagnosis and treatment adherence using SMS (text message) reminders.
E-Health Card user interface
Based on the data collected by the ASHAs, nurses at peripheral health and wellness centers screen the population determined to be at risk. Those who screen positive for a disease are then referred to primary health facilities for diagnosis confirmation and appropriate treatment. The utility of the E-Health Card is in providing a platform for data verification and decisional support at all levels of care, as well as providing an individual citizen access to their own health information in a centralized location.
The E-Health Card is part of a larger digital Management Information System (MIS) that Dr. Chaudhury conceptualized for program monitoring of the HealthRise India project. The MIS tracks each patient through the screening, diagnosis and treatment process to follow up for compliance. Patient level data is accessible by different levels of program managers, which enables them to monitor patients more efficiently and report on case updates. Additionally, the MIS has a user-friendly dashboard for decision making and report generation, which further improves the efficiency of the patient follow-up process. Before the implementation of the HealthRise MIS in India, patient data collection only occurred at the level of a district hospital. Now, the HealthRise MIS allows the capture of patient-level NCD data at the primary care level.
Through this project and other collaborative efforts in progress, Dr. Chaudhury, along with the HealthRise India team, has helped to fulfill Medtronic Foundation’s vision for sustainability and scalability of best practices for global health in India. The engagement of the public, private and non-profit sectors was critical to the success of the E-Health Card and continues to be important as Medtronic Foundation works to effectively address health and specifically NCD burdens on a global scale.