The popular science presentations emerging through this project were geared primarily towards the development of 'frugal' design strategies in international settings to be introduced to students, academics, industry and policymakers in the health department at the state and national levels. Student exchange and new course design became an important part of the mutual learning process to enable more robust and scalable systems in both Norway and India.A PhD student from PGIMER was sentral for the successful implementaion of 'living lab' at 2 sites, supported by DHIS2 group at UiO, Norway and its Indian partner HISP India and unvaluable great support from PGIMER.
The establishment of 'living lab' served as a hub to test design strategies in field settings. The shared experience from a medical officer perspective was given at the very last workshop. Among the advantages mentioned was increase of reliable data, follow-ups and tracking of individual patient, easy to search records and easy to generate reports. The shift from paper system-aggregate reporting to case based data and ease of monitoring has lead to more fault findings. Among the system advantages is the support of evidence based decision making, its analytical features on interactive dashboard and the in fact it meets all basic requirement of primary health care system.
As a result of the project dissemination activities, a new strategy for deployment of project results were introduced, and lead to development work on AMR (Antimicrobial Resistance) Surveillance system. This work is still ongoing.
The design and development of a 'patient centric system for primary care settings in the Indian context 'is fully operational in the primary health care clinic in Chandigarh. A living lab, a core concept guiding the project, was established and made operational through this project. Research outputs: 1 book, 6 lectures and 3 articles for international conferences and journals for multi-disciplinary audiences. Two IFI Masters students successfully completed their thesis based on this project. PGIMER doctoral student will be submitting his thesis in July based on this project. 5 more research papers are under production. A course module on Public Health Informatics for medical/public students were build and is actively used. At external level further impacts may be earlier detection of epidemies by reporting real time patient data from slum areas to the authorities. At the UiO internal level possible impact is building competencies across the workforce.
Many LMICs are seeking to strengthen PBCS within their public health settings. Contributing to this is the drive towards Universal Health Coverage (UHC).UHC, which seeks to provide financial risk protection to all citizens, requires collecting patient and encounter based information, including costs, to help monitor and measure progress towards achieving UHC. As NCDs like diabetes and hypertension is rapidly increasing, UHC requires collecting data for such diseases that go beyond the traditional concerns of maternal and child health services that exist in LMICs.
The project focus is on learning to design PBCS and incorporate this learning in post graduate health informatics curriculum. This curriculum includes design approaches, implementation concerns, using information for action, capacity strengthening & regulatory concerns.
There is limited experience and understanding in LMICs of how PBCS can be designed and used, especially within the primary health care sector. Transitions from existing aggregate and also often paper based HIS to such PBCS is a non-trivial challenge. The near absence of regulatory environments to ensure privacy and protection of patient data represents another significant challenge, especially now when there will be a proliferation of private and global providers in addition to the State. Infrastructure and capacity constraints, especially in the outreach areas of the primary health care sector, provide severe challenges to the creation of such PBCS, which are fundamentally dependent on the Internet to enable connected care.
These technical and institutional challenges have been understood in Norway with more than 3 decades of experience in this area. The project seeks to transfer these learning to the Indian context through joint research, curriculum development, student exchange and joint workshops to be held in Norway and India. The involvement of the private/NGO sector will be sought to strengthen larger dissemination of results.