This project was done in collaboration with Aditya Bansal over the span of 1 week for Salesforce’s Design Challenge, for which this entry was awarded the 1st position.
We have tried to explore the long term health ramifications of COVID-19, and how doctors, medical researchers, and health officials can keep track of this information to build future policies.
7 Days, Salesforce Design Challenge(1st Position)
COVID-19 is currently on a warpath against humankind. Though its fear has now subsided as people attempt to return back to normalcy, its long term effects on health are still largely unknown due to lack of data and research. Broadly speaking, COVID-19 affects three main organs: heart, lungs, and brain (mental health.) There is no knowing how badly the three organs are affected, whether their complications are hereditary or not, etc. This can only be researched upon when a sizable amount of data has been gathered, from all over the country, irrespective of any constraints or parameters.
Presenting to you, Corona Kawach Abhiyaan, a medical record-keeping system by the Ministry of Health and Family Welfare, India.
#1: Why do we need long term tracking?
Out of the 32 million cases per date, no two cases of COVID-19 have been identical in nature. Every case has exhibited its own mannerisms, based on the lifestyle and the pre-health conditions of the patient. COVID-19 affects mostly 3 major organs, the lungs, the heart and the brain. It leaves a lasting impact on these organs as people contract deadly diseases such as pulmonary fibrosis and cardiac injury, which leads to millions of deaths in a year worldwide.
These physical health conditions leave a lasting impact on your mental health as well, which is another cause of concern. We have hence attempted to establish as to why we need to research upon these complications.
The present healthcare system in India is highly grappled with issues such as internet connectivity, lack of expenditure, etc. India’s healthcare has been highly criticized internationally by WHO as well, which is why it leaves a wide scope for improvement for us to work on.
#2: What is the existing system of tracking health?
The present solution, pre-COVID for medical research to be gathered, was through electronic health record portals. These portals have their own limitations, however they have various advantages as well.
EHR is a digital version of a patient’s paper chart. EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users. While an EHR does contain the medical and treatment histories of patients, an EHR system is built to go beyond standard clinical data collected in a provider’s office and can be inclusive of a broader view of a patient’s care.
Uses based on Stakeholders
For healthcare practitioners, who are interested in clinical analytics, it can help in personalizing treatment, monitor health, consult remotely and utilize predictive health analytics for decision making.
For the government, unified data on patients can help identify patterns and analyze trends at regional, national, or disease-specific levels in a population. It can also help the government to develop health policy, interventions, programs for specific demographics prepare, and respond in healthcare emergencies.
For healthcare providers, like labs and hospitals, healthcare analytics entails structuring data to its longitudinal form, which can help in mapping patients’ health journey, and contribute to improved healthcare outcomes.
For pharmaceutical companies, including their various internal divisions such as R&D, sales and marketing, the benefits of advanced analytics, artificial intelligence and machine learning can be utilized in drug discoveries, market assessment, brand intelligence, customer outreach, and engagement.
For patients, health data can encourage patients to be proactive participants in the care process. This is in contrast with the more traditional medicine approach in which doctors have the control and make the final decisions.
Constraints of EHR (present system)
The constraint of Low education/tech proficiency wrt EMR/EHR
Based on a survey carried out in 2014, around 77% of doctors and hospitals in India have started using fully or Partially EHR system to keep a record of patients. But the usage is partial to many doctors and a lot of small clinicians are not included. Plus if we go by the survey only, some 23% haven’t still explored EHR that shows the tech gap in between doctors and how it is important to design something that they find usable also whatever system is designed, it’s important we educate and motivate them to use it.
Constraint of Privacy
Privacy of patients is the most important task that we need to take care of, it’s important to ideate an authentication system. Patients need to be assured that the confidentiality of their health data will not be compromised. Healthcare providers also have to be assured that whatever they record will not be altered without their knowledge.
Constraint of Research
The government needs to collect the health information of individual patients for use in public health decision-making or clinical research. Legislation must provide a mechanism to use clinical information after necessary anonymization. Clinical decision-making may be subjected to medical audit for several purposes; therefore, the records must be made available for a reasonable period.
The constraint of Data Input and Participation
As more than 75% of outpatients and more than 60% of inpatients are being treated in private healthcare facilities, it is necessary for the government to bring them on-board for using EHR. In view of the size of the country, there is a need to take a FOSS approach to make good quality software available to hospitals and individual practitioners. It should support all major national language scripts. If it is in the FOSS domain, even local entrepreneurs can provide technical support.
The constraint of Data Storage
It is required for the exchange of EHR among healthcare providers. An HIE finds patient data at other institutions using a master patient index, collects the information for the patient, and records the transaction for subsequent audit. HIE is also responsible for authentication of the person accessing the information while meeting the privacy requirements of the patient. The government needs to establish and maintain these exchanges in partnership with the private sector.
#3: Who are our stakeholders?
Though there are multiple parties to work with as mentioned here, we will be discussing the 4 primary stakeholders and how they interact with each other.
This is the stakeholder map that connects all the stakeholders. Let us now see this scenario that maps the system: The patient gets to know about incentivized testing that the government is providing, and visits a hospital or clinic. The establishment, based on whether they have internet or not, publishes the report as an OCR sheet or uploads it directly to the portal. The patient can get a hardcopy of the logbook or they can have their reports published online directly. Using these two media, the patient can keep a progressional track of their health and then go to hospital when needed consultation. All this information will hence be made available to researchers and health officials.
Persona + User Journey
Mr. Ratan Shah, our patient, contracted COVID in May 2020 and is apprehensive about his health. He needs to go for an annual health check up to get his sugar tests done.
2: Doctor (Hospital)
We have Dr. Prisha Soniwal, who is a cardiologist at AIIMS. She wishes to have a fulfilling personal and professional life by not wasting time in bureaucratic work such as report maintenance.
3: Doctor (Individual Clinic/Low Internet connectivity)
We have Dr. Shaan Awasthi who runs a small clinic in Rohtak. He’s a successful, brilliant doctor, however he is not very tech savvy. Moreover, where he practices, the internet is unreliable and available only for a few hours of work.
Lastly, we have Dr. Anamika Singh, a medical researcher working on COVID-19 and its complications. She receives consolidated data through Blockchain encryption from all hospitals which is then visualized in varied formats.
Solution: Corona Kawach Abhiyaan (CKA)
Corona Kawach Abhiyaan is India’s answer to COVID-19. It is a system of information flow, with an electronic medical record portal at the centre of the solution.
The flow of information starts with the health officials, associated with the Ministry of Health and Family Welfare. They provide incentives to ex-COVID-19 patients to get their testing done from places that are linked to CKA, through the medium of print media and electronic media.
If they have an internet connection: The patients then get themselves tested, while their results are uploaded on the portal, accessible to their doctors (as per their consent) and themselves. The portal sign up is through your Aadhar Card No. since that is accessible to a wide number of Indians.
Patients can take up a survey as well voluntarily on the portal to aid the government with information collection and it would allow help them in early detection of some possible complications which they may have not known.
It is important to understand that 20 years from now, people would want to forget the pandemic and would not like to get themselves associated with it, so under CKA we will make modifications in the existing health ecosystem like making changes in the Apple health app, adding a separate section.
It’s true that not every patient has the internet to operate or is interested enough for the same or doesn’t have the required tech like smartphones or laptops, CKA also tries to bring in such people within the system too. Under CKA, government through means of different channels would provide a physical health logbook to citizens which they can use to keep a record of data such as pulse, Diabetes.
Practicing individually or part of a Hospital, the government under CKA will provide them with a portal specially curated for their needs. The doctor’s EHR Portal would allow them to carry out multiple tasks with ease, Traditionally doctors face performance constraints when it comes to using EHRs, however it is an important medium, which is why we need to refine it instead of replacing it.
It would start with a simple registration, they can transfer the data from existing her portals, facilitate a connection between them and they can even use their hospital’s SSO login ID.
Part of the solution we iterated multiple screens of what could be the portal design, as you can see different sections under it fulfilling different purposes.
They can then manage their patients on the dashboard, see their appointments, and reports all at one place for easy bookkeeping. They can also update and upload existing records, and can further download and share the results generated by the system. This information, now available to the respective doctors as well, can be shared, commented upon, and analyzed from any place at any time. The doctors can, if they want to, share it with doctors within an establishment as well for their expert comments.
If they don’t have an internet connection: For doctors who do not have full-time internet connectivity, an OMR sheet Logbook is provided so that they can upload the details later on the portal as per their convenience. By this, we are including the doctors who do not have 24*7 access to the internet. OMR sheets segregated on the basis of Health tests, For example, Blood OMR sheet, Blood OMR should contain spaces where a doctor can fill in the patient’s blood reports results, These sheets would also help to keep a better physical record of a patients health.
All this information is stored and encoded using Database Management, Blockchain, and data cloud. Only the information that pertains to COVID-19 is shared with researchers in a consolidated manner, it would provide valuable info to researchers such as effects specific to COVID strains, outbreak mapping, vaccination results etc. If required, private in-depth medical history of an individual can be shared with the researchers, but only at the consent of the individual themselves.
Researchers then share this data with health officials in the form of reports and their findings. Health officials then use this information for further policymaking.
The flow of information will be through Blockchain encryption.
How does it work:
In this it’s important we identify areas of Importance for COVID Track and Research, such details necessary are stored at two places, But before that segregation of such information is vital from the rest. EMR portals have to do the same based on guidelines provided by the government that cover all data they need. Now, this data of COVID is stored at the local EMR server and via a separate Blockchain channel it is also transferred to the Government made portal.
In a blockchain, every member of the community holds its own local copy of the shared dataset. When one entity wishes to make a change to that data, the potential edit must meet a series of cryptographic criteria that confirm the identity of the entity making the change. Every member of the community must authorize the transaction before it can be confirmed, then each local copy of the data is changed to reflect the activity.
The edit is then turned into a “block,” or a fixed event that had been approved and locked into place. Over time, each block is added to the “chain” of events, thus leading to the methodology’s moniker.
- Global Ramifications: Since COVID-19 has impacted everyone around the world, any research breakthrough in it will have a global impact.
- Inclusiveness: Our solution is not 100% dependent upon the internet. Since, in India, there are various places that do not receive 24*7 internet, we have devised an offline solution as well.
- Save Lives: By tracking the changes early on, we’ll be saving the lives of millions of people.
CKA will impact countless lives by helping everyone people asymptomatic of their diseases or not, have internet or net, doctor, clinicians etc. It creates an accessible database that helps in early detection and is not exclusive to the selected class. With CKA we endeavour to help a billion lives.