Updated: November 15, 2016 12:38:03 am
In his Independence Day address Prime Minister Narendra Modi talked about the digitisation of AIIMS, the country’s largest public hospital. He said, “when people used to come to AIIMS, they had to wait for two to three days to just know when they will have to undergo tests. We have been able to change that system. There is provision for online registration and seeking online appointment with doctors. A patient’s medical records are available online. We want to develop this culture throughout the country with respect to healthcare systems.” As an AIIMS employee for the past 13 years, I must say that digitisation has changed things. But unfortunately the picture is not as rosy as described by the prime minister.
Digitisation has meant extra waiting time for patients coming from outside Delhi. Most emails and phonecalls seeking appointments are from people from the upper strata of society. Email access or access to a physician’s contact number is restricted to those who can read and write and have access to a computer or a mobile phone. Digitisation of the process of outpatient appointments threatens to restrict the common person’s accessibility of healthcare.
The digital appointment system at AIIMS was launched in July 2015. As part of the “transformation” drive at AIIMS, the institute’s security was beefed up, various outpatient gates were designated and patients could seek appointments online or on the phone. It thus became almost impossible for patients to physically approach doctors without prior appointments, for which there were long waiting periods. So some may ask how is this different from the past? In the past too, AIIMS’s outpatient departments were flooded with patients and the waiting times were equally long. But in those days, the human element prevailed and patients found their way to consultation chambers as a result of the courtesy of kind paramedics, nurses and onsite staff (I agree there was a risk of corrupt practices but these risks persist with online procedures).
On questioning an enthusiastic employee of the Tata Consultancy Services (TCS), which is among the agencies involved in the digitisation of AIIMS’s OPD appointment system, I was told that the measure was part of a “crowd management” policy. Crowd management? I was reminded of Delhi police constables controlling protesting crowds at Delhi’s Jantar Mantar. TCS, it appears, is confused between transforming the country’s passport issuing service (a task it has, undoubtedly, performed well) and transforming the nation’s largest and busiest public hospital which deals with the sick and the dying.
It could be argued, in favour of the digital appointment process, that we cannot let the “human element” delay the process of digitisation — an essential requirement for any modern day healthcare system. Yes, we shouldn’t but in a country like India where poverty, illiteracy and caste play significant roles in how people access healthcare services it would be imprudent to ignore the importance of a thinking person mediating between the patient and the physician. It is impossible to imagine that digitisation alone can bring a patient to a tertiary healthcare centre, particularly because we lack a robust referral system. A referral service would have been far better and a useful “gate-keeping” instrument than actually restricting patients in the name of crowd management.
The problems of an one-size-fits-all implementation strategy for online patient registration and clinic appointments in an underdeveloped country — and in developed countries as well — are well known. A study from China revealed that around 90 per cent patients showed reluctance in adopting an online appointment system. The reasons for their reluctance included lack of access to the internet, low computer skills and incompatability of the online appointment service with patient requirements. I am sure such factors hobble the online appointment system in India as well.
There is no doubt that digitisation leads to transparency, ensures patient follow-up and improves healthcare delivery but the perils of hastily digitising a hospital like AIIMS, which caters to the poor and illiterate, should have been obvious to the policymakers. Healthcare systems should be digitised in a slow and inclusive manner. There should be flexibility in procedures to ensure that patients are not sacrificed at the altar of crowd management. Strengthening the prevailing peripheral healthcare set-ups and linking them to tertiary centres like AIIMS will ensure a better referral system. Technology does have an important role in the delivery of healthcare, but not to be aware of ground realities in the country is the worst misuse of technology.
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