Digital Health in India_Health Informatics Trained Manpower _DrDevTaneja_15.06.2024.pptx

Digital Health in India will need an army of Health Informatics-trained manpower in India.

Presently, in healthcare, most of the work is done by generalist IT manpower as trained Health IT resources are not readily available. Academic courses for Health Informatics are not readily available in Indian pre-university & university-level education.

We look at the evolution of Health informatics, HIMMS TIGER resources for training, and the strategic need for Health & IT Academia and industry to collaborate in India to introduce Health Informatics Courses in India.

This will need an advocacy push from various stakeholders in India to proactively start Health Informatics academic courses in India on a big scale.

Health Informatics has a huge employment potential and can provide big business opportunities in the healthcare industry. A big pool of trained Health Informatics manpower will also lead to product and service innovations on a global scale.

1. Digital Health in India Are we ready with the Health Informatics trained Manpower? Ground Realities of Health Informatics Evolution & Resources Strategic Academia & Industry Collaboration Opportunities, Possibilities & Challenges Dr Dev Taneja M.S. (Gen. Surgery) MBA - Healthcare Mgt. (NUS Business School, Singapore) 15 th June 2024

2. Background of Health IT Manpower in India In India most of the work in the healthcare industry is done by the generalist IT professionals Health Universities don’t teach Health Informatics and IT Education institutes don’t teach Health IT The digitization of Indian healthcare is picking pace due to a policy push from the Niti Aayog & the government The Business Process Outsourcing market in India is projected to  grow by 8.76 % (2024-2029) resulting in a market volume of US$10.94bn in 2029. source: ( https://www.statista.com/outlook/tmo/it-services/business-process-outsourcing/india ) Neither the government nor the healthcare academia or the healthcare industry is showing an urgency to improve training & supply of trained Health Informatics manpower in India Health informatics-trained manpower needs advocacy from various stakeholders Health Informatics has the potential to create millions of jobs and billions of dollars in revenue Health Informatics trained manpower pool can provide Health Innovation opportunities 2

3. What is Digital Health? Digital health, or digital healthcare, is a broad, multidisciplinary concept that includes concepts from an intersection between technology and healthcare. Digital health applies digital transformation to the healthcare field, incorporating software, hardware and services Under its umbrella, digital health includes mobile health ( mHealth ) apps, electronic health records ( EHRs ), electronic medical records (EMRs),  wearable devices , telehealth and  telemedicine , as well as personalized medicine Terms related to digital health include  health information technology  ( health IT ),  healthcare tools ,  health analytics ,  healthcare informatics ,  hospital IT  and  medical technology . Source: https://searchhealthit.techtarget.com/definition/digital-health-digital-healthcare#:~:text=Digital%20health%2C%20or%20digital%20healthcare,incorporating%20software%2C%20hardware%20and%20services. 3

4. Technology & Policy Changes in the Education Landscape The education sector has been consistently trying to to modify the archaic courses & jaded policies to replace it with innovative teaching-learning methods to introduce educational excellence 4

5. National Medical Council suggests choice-based credit courses for Medical students They have suggested areas such as the use of artificial intelligence and computers in health and medical education They are short-term Generic courses mandated by the NMC with the intention of broadening medical students’ awareness of developments beyond the medical field Students may undertake as many courses as they can cope with, and it allows them to choose intradisciplinary courses, providing more flexibility. 5

6. Golden Age of Biological Science 21 st century will be Golden age of marriage of engineering and biology sciences Which will bring many innovative solutions to mankind Source: https://www.slideshare.net/DrDevTaneja/future-of-healthcare-dr-dev-taneja Delivered at RMA Conference, Mahad on the 8 th Jan 2006 6

7. The Clinical Perspectives in Health IT In India, HIS are mostly used for transaction reporting systems whether in hospitals or in individual office based clinical practice management software The potential of using Clinical Information Systems to improve Clinical Care, Clinical Quality and Clinical Outcomes is still not being appreciated by the healthcare community HIS applications in Chronic Disease Management and Clinical Decision Support Systems are rudimentary in India at present Source: Digital Technology in Hospital Administration; A Strategic Choice - Taneja D, Kulkarni SV, Sinha S, et al. J Assoc Physicians of India 2023:https://doi.org/10.59556/japi.71.0372 7

8. Applications of Digital Health Source: Digital Technology in Hospital Administration; A Strategic Choice - Taneja D, Kulkarni SV, Sinha S, et al. J Assoc Physicians of India 2023:https://doi.org/10.59556/japi.71.0372 8

9. Aims of Digital Health The U.S. Food and Drug Administration ( FDA ) website states: "From mobile medical apps and software that support the clinical decisions doctors make every day to artificial intelligence and machine learning , digital technology has been driving a revolution in health care Digital health tools have the vast potential to improve our ability to accurately diagnose and treat disease and to enhance the delivery of health care for the individual 9

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11. The pilot project of National Digital Health Mission had been announced by PM Modi from the ramparts of the Red Fort on August 15, 2020 . Under this, a unique digital health ID - ABHA CARD will be provided to the people, which will contain all the health records of the person . Ayushman Bharat Digital Mission

12. How Health Informatics is Evolving Globally?

13.           Source:  Towards the TIGER International Framework for Recommendations of Core Competencies in Health Informatics 2.0: Extending the Scope and the Roles Source: https://www.himss.org/resources/health-informatics 13

14. Aligning Core Health Informatics Competencies However, there is an issue. Healthcare providers often receive poor or nonexistent education in informatics and the use of information technology to advance care during their professional formation. Physicians, like there nurse team members, will also need to interact competently with IT and informatics processes . Although no unified documentation on expected informatics competency for general medical education is available through the American Association of Medical Colleges (AAMC), T he Accreditation Council for Graduate Medical Education (ACGME) does  lay out the program requirements  for fellowship in clinical informatics for graduates  14

15. For all medical education, Oregon Health & Science University did document  specific learning objectives and milestones   to support developing informatics competent medical practitioners. The team offered multiple competencies across the continuum of medical education. Among them are: Apply personalized/precision medicine Engage in quality measurement selection and improvement Engage patients to improve their health and care delivery through the use of personal health records and patient portals Find, search and apply knowledge-based information to patient care Maintain professionalism through the use of information and technology tools Participate in practice-based research Protect patient privacy and security Provide clinical care via telemedicine Use and guide implementation of clinical decision support Use health information exchange (HIE) to identify and access patient information across settings Use information technology to improve patient safety 15

16. A Gap Those responsible for educating or training the students or current providers, despite mandates to do so, are themselves often lacking in knowledge, skills and attitudes so that there is not a transference of knowledge and skill that results in a demonstrable competency. These faculty members were most likely not educated about informatics during their own time in school and perhaps not even during clinical practices. This results in an informatics skill and competency gap among graduates. For nursing, this significant gap has been identified by the  HIMSS TIGER  ( Technology Informatics Guiding Education Reform ) initiative, the  European Commission’s EU*US eHealth Work Project , and the Nursing Knowledge Big Data Science Education Work Group. A synthesis of results  pointed to several major gaps  related to training and skills, the top four address: Availability of courses and programs Lack of knowledge and skills of faculty and educators Lack of knowledge and skills of providers and caregivers Quality and quantity of training materials. Moreover, research  identified the pressure placed on universities  to deliver eHealth education in a curriculum wide approach for which the universities are struggling to meet the needs for applicable and novel learning opportunities. 16

17. A Solution and Resources Given the serious need to have health professionals and graduating health professional students competent in the provision of quality and safe care using IT and informatics processes, faculty and educators providing the knowledge, skills and attitudes on the topics must themselves be competent . Moreover, given that there are not enough health professionals with formal informatics education and training to take on this challenge, support must be provided to those who currently interact with the profession and the students. TIGER International Competency Synthesis Project The  TIGER International Competency Synthesis Project ’s Global Health Informatics Competency Recommendation Frameworks provide a comprehensive and compiled core set of international and interprofessional informatics competencies for nursing and other healthcare professionals . The second, more expanded set, align with all health professions across multiple levels . This expanded set contains four domains under which multiple competencies align : Biostatistics and technology Data, information and knowledge Information exchange and information sharing Management in informatics 17

18. Resources As stated previously, despite all of this competency work and the expectations across various health professions, there is a significant gap. The gap is exacerbated by the knowledge, skills and attitudes of those currently teaching and educating. So, rigorous support and guidance has to be provided to those educators and faculty. There are tools to help, including the following. Global Health Informatics Competency Recommendation Framework 1.0 (nursing) + 2.0 (interprofessional):  This  describes the framework with all the domains and competencies . A review of this document will demonstrate an alignment with the core informatics expectations of the AACN, AAMC, ACGME and AAPC. Health IT Competencies Tool & Repository ( HITComp ):  This web-based tool that lets you  explore specific competencies, sub competencies   across roles and education . It is aligned with the Global Health Informatics Competency Frameworks and serves as a  detailed companion guide . Interactive Education Demonstrator Modules:  These modules provide instructional videos on the foundational curriculum, HITComp and  cybersecurity  focused on targeted malware attacks. Skills Knowledge and Assessment Development Framework (SKAD)  is a  questionnaire focused on self-assessment  to better understand personal digital literacy skills. Today, more than ever, there is a major need to improve the informatics competency and skills of not only of the healthcare workforce but of those who teach and guide them. These tools offer an opportunity to address the gap in both areas. Source: https://www.himss.org/resources/health-informatics 18

19. Demand for Health Informaticists According to the U.S. Department of Labor’s Bureau of Labor Statistics, health informatics will experience a  22% job growth between 2012 and 2022 . The salary for these positions exceeds $100,000 . (more than Rs. 7 Lakh/month) Variety and opportunity are vast for those interested in pursuing a career in the field. Keep in mind that many of these jobs require skills from different disciplines. Many of these positions remain open longer than the average meaning that opportunities abound for the well prepared. 19

20. Health Informatics: India's Digital Euphoria According to NASSCOM, the demand for health informatics professionals in India is projected to surge by a remarkable 250% from 2022 to 2030 . This explosive growth underscores the essential role health informatics will play in shaping India's healthcare future. India: A Global Epicenter for Health Informatics Talent: IDC: The premier global market intelligence firm foresees India emerging as the world's second-largest market for health informatics talent by 2030 . This accolade positions India as a prominent hub for healthcare and technology convergence. The Most Sought-After Skills: Data Analysis, Clinical Informatics, and Software Development: IDC highlights the key health informatics skills in high demand in India: data analysis, clinical informatics, and software development. Expertise in these domains will be the bedrock of transformative healthcare solutions. Bridging the Talent Gap: A Call to Action: The Health Informatics Society of India (HISI) paints a concerning picture - a projected shortage of 1 million health informatics professionals by 2030. India's Edge: A Pool of Proficient Healthcare Professionals: India's strength in health informatics lies in its vast pool of skilled and experienced healthcare professionals . This existing talent pool forms the backbone of India's efforts to fill the talent gap and redefine healthcare standards. Technology-Powered Growth: Pioneering Health Innovations: IDC identifies technology's role as the driving force behind health informatics growth in India . Electronic health records, telemedicine, and big data analytics are set to revolutionize healthcare , propelling health informatics professionals into the vanguard of transformative health solutions. Source: https://www.linkedin.com/pulse/health-informatics-indias-digital-euphoria-kranthi-kumar/ 20

21. Health Informatics Branches The field has many branches. There are multiple paths to follow, including that of data scientists (although data science is considered a related and overlapping discipline). The need for competent health informaticists and data scientists is growing exponentially. Additionally, the amount of data produced by the healthcare industry is expected to grow exponentially, creating opportunities aplenty in the following areas and others: Clinical Informatics Consumer Health Informatics Nursing Informatics Pharmacy Informatics Public Health Informatics 21

22. 1. Clinical Informatics Professionals working in clinical informatics use data to support clinical decision making. A clinical informaticist may serve in a multitude of roles, depending on the size of the healthcare setting. 2. Consumer Health Informatics Consumer health informatics roles involve protecting consumer health . 3. Nursing Informatics The American Nurses Association  defines the position  as overseeing the integration of data, information and knowledge to support decision-making by patients and their healthcare providers. Nurses with technological skills may want to consider looking for a job in this field. While the Bureau of Labor Statistics does not track nurse informaticists specifically, the demand for computer systems analysts - a role with comparable skills - is  expected to grow faster  than other occupations over the next few years. 4. Pharmacy Informatics Pharmacy informatics involves using data in the process of supplying medication . Demand for pharmacy informatics is growing rapidly due to the wide spread use of electronic prescribing and EMRs. 22

23. 5 . Public Health Informatics Public health informaticists concern themselves with the health of populations . Some people in this field prepare for threats such as antibiotic resistant infections and biological attacks. Public health informatics jobs are found in hospitals, government agencies or private businesses. Healthcare has always been data driven . As more and more data are created the need for health informaticists with the mix of proficiencies in communication, computer science and clinical capabilities will be in great demand for years to come . Using data and computer systems has the huge potential for improving quality, improving the user experience and lowering costs and is one of the few areas in healthcare where providers, insurers and policymakers of both parties agree. This is also one of the areas of consistent job growth. The opportunities are there. Now go after those proficiencies. 23

24. My Perspectives on Digital Technology Module Courses - An Interdisciplinary Academia & Industry Approach 24

25. HIMMS Certified Associate in Healthcare & Information Management System (CAHIMS) What is Taught and Evaluated? Healthcare Environment 2. Clinical informatics 3. Healthcare information & Management System Analysis, Design, Selection, implementation, support & maintenance Testing & Evaluation Privacy & Security 4. Management & Leadership ( Source: https//:www.himms.org - Health Information & Management Systems Society ) 25

26. In the United States,  clinical informatics  is a  subspecialty  within several  medical specialties . I n  pathology , the  American Board of Pathology  offers clinical informatics certification for pathologists who have completed 24 months of related training, and T he American Board of Preventive Medicine offers clinical informatics certification within  preventive medicine In October 2011 American Board of Medical Specialties ( ABMS ), the organization overseeing the certification of specialist MDs in the United States, announced the creation of MD-only physician certification in clinical informatics. The first examination for board certification in the  subspecialty  of clinical informatics was offered in October 2013 by  American Board of Preventive Medicine  (ABPM) Fellowship programs exist for physicians who wish to become board-certified in clinical informatics. The fellowship is open to any of the 24 subspecialties recognized by the ABMS The fellowship program is 24 months in length, with fellows dividing their time between Informatics rotations, didactic method, research, and clinical work in their primary specialty . Source: https://en.wikipedia.org/wiki/Health_informatics C linical I nformatics  26

27. Clinical / Medical Coding A  clinical coder - also known as  clinical coding officer ,  diagnostic coder ,  medical coder , or  nosologist - is a  health information professional  whose main duties are to analyse  clinical statements  and assign standardized codes using a  classification system A clinical coder may use a set of published codes on medical diagnoses and procedures, such as the  International Classification of Diseases  (ICD), the  Healthcare Common procedural Coding System  (HCPCS), and  Current Procedural Terminology  (CPT) for reporting to the  health insurance  provider of the recipient of the care The codes may cover topics related to  diagnoses ,  procedures ,  pharmaceuticals  or  topography . The medical notes may also be divided into specialities for example  cardiology ,  gastroenterology ,  nephrology ,  neurology  ,  pulmonology  or  orthopedic  care A clinical coder therefore requires a good knowledge of  medical terminology ,  anatomy and physiology , a basic knowledge of clinical procedures and diseases and injuries and other conditions, medical illustrations, clinical documentation (such as medical or surgical reports and patient charts), legal and ethical aspects of health information, health data standards, classification conventions, and computer- or paper-based data management, usually as obtained through formal education and/or on-the-job training 27

28. World Health Organization(WHO): Family for International Classification codes These includes classification codes as follows: ICD 10 – International Classification of Diseases and other derivative classifications ICD 9 PCS – List of procedure codes ICF – International Classification of Functioning, Disability and Health ICHI – International Classification of Health Interventions ICD-O – International Classification of Diseases for Oncology In practical use, we recommend that you gather the data using SNOMED CT for finer granularity and flexibility in analysis. When required later you may map the required SNOMED CT codes to ICD for statistical analysis and reporting purposes. In summary, health records system should use SNOMED CT for terminology and WHO family of codes for classification reports. It is important to ensure that your digital health systems incorporates these coding systems for semantic interoperability of EHR. It also makes the data semantically rich and computable. 28

29. Academy of Medical Coders of India POST GRADUATE DIPLOMA Medical Coding Medical Records Technology EXECUTIVE DIPLOMA Medical Coding Medical Records Technology The offered training programmes in medical coding are approved and certified by Quality Council of India (QCI), Government of India. IGMPI is affiliated with Life Sciences Sector Skills Council (SSC) and Food Industry Sector Skills Council set up by National Skill Development Corporation (NSDC), Ministry of Skill Development and Entrepreneurship, Government of India as well . Source: https://www.igmpiindia.org/medicalcoding.html 29

30. Bioinformatics to solve major healthcare challenges The course aims at the application of Computer Sciences in the field of Biology Bioinformatics entails the creation & advancement of databases, algorithms, computational & statistical techniques and theory to solve formal and practical problems arising from the management & analysis of biological data 30

31. Digital Health Module should include Introduction to Health IT Why Digital Health is so easy & Why it is hard - OPD, IPD & Emergency care Clinical Informatics in Emergency & IPD Health Apps & Wearables EMR / EHR / PHR Health Informatics / Data Analytics Health IT Standards - SNOWMED CT & LOINC for Clinical data - HL 7 for exchanging data between systems - HIPPA / HITECH for the privacy of personal health information - Standards for devices and software - FDA certifications 31

32. Future of Digital Health   Precedence Research   projected that the global digital health market will see a compound annual growth rate (CAGR) of 27.9% from 2020 to 2027 when it will reach $833.44 billion The COVID-19 pandemic has increased demand for personal health monitoring via wearables, straddling the line between consumer and medical devices.   HealthCare Startups - Top Innovators ET Startup Awards 2021 Qure.ai (AI based Radiology Services) - 3 Health IT related Business Startups were shortlisted for the awards New Career opportunities for students 32

33. Should Health Universities, IT Education institutions & healthcare industry undertake this journey? YES Strategically By Design or By Push

34. High Academic Excellence, Low Health IT Capability Strategy High Academic Excellence, High Health IT Capability Strategy Lower Academic Excellence, Low Health IT Capability Strategy Lower Academic Excellence, High Health IT Capability Strategy Lower Higher Academic Excellence Higher Lower  Health IT Maturity 34

35. Strategic Positioning for Health Universities Brand The Aim is to push the Academic Excellence and health IT frontier outwards and create a competitive advantage on a sustainable basis. Advantages Pioneer Health University to start the Health Informatics Dept. In India Higher National & International Rankings Branding & Visibility Attract Good Faculty, Students Research & Innovations Academia & Industry Partnerships Contribute to Public Health – Health IT Policies, Solutions & Research S trategically by Design & Not by Push A C A D E M I C EXC Health IT Maturity & Research High Low Low Medical Sci . High Engg . Sci. IT Capability Research & Innovations 35

36. Traditional performance of Health Uni. 1.2.3… Health Sciences’ University Academic Excellence Health IT Maturity Aligned Faculty & Students Multidisciplinary Approach per NEP & NMC Research Innovation & Industry Partnership Academic Partnerships New trajectory Most-demanding Health University, IT Education Institutes & Healthcare Industry Collaboration Least-demanding Time 36

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38. Should We Do It ???????

39. Thank You Contact Info: Dr Dev Taneja Mobile: [phone] E-mail - [email protected]