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AI technology on clinical decision system can help India in primary and secondary healthcare: Study

Gireesh Babu, New Delhi
Wednesday, September 1, 2021, 08:00 Hrs  [IST]

An integrated clinical decision support system (CDSS) using artificial intelligence (AI) could be useful to health workers in primary and secondary healthcare settings to overcome the present challenges including a lack of adequate manpower in the system, according to a study sponsored by NITI Aayog and UK-Department of International Trade.

The feasibility study, Healthcare Artificial Intelligence Catalyst (HAIC) pilot study was initiated to assess the usability, usefulness, and adherence to standard treatment guidelines in Indian healthcare settings with the use of Elsevier’s Arezzo declarative artificial intelligence-based clinical decision support system and pathway technology. A latest report from the team, conclusively demonstrated the feasibility to transform country guidelines and create advanced data analytical tools to develop a customised clinical decision tool for the purpose, despite several challenges faced in the process.

The Principal Investigator Team for the study is from Lady Harding’s Medical College and All Indian Institute of Medical Sciences, New Delhi.

“We also established that the integrated CDSS is usable and useful to health workers in primary and secondary healthcare settings and is preferred by over three fourths of the users for continued adoption,” said the report released by NITI Aayog.

Provision of Arezzo customized for Indian guidelines-based recommendations empowered the frontline worker as it acted as an able job aide with resultant improved recognition of high-risk cases in the community. It showed added potential for efficient task share and task shift of care across the health care functionaries.

“The study results are convincing enough to support development of next version tools with further enhancements,” it added.

It is pertinent to note that the quality of primary healthcare is severely affected by the strain on primary healthcare centres (PHC) where the PHC, usually led by one doctor, is expected to provide comprehensive primary care for up to 30,000 residents.

There is a shortage of 10,907 auxiliary nursing midwiferys (ANMs) as against the required number of 1,84,160 and there is a shortage of 3,773 doctors at PHC as against the required number of 25,743. A similar shortfall is experienced in the count of other specialists and health personnel, says the study.

Other challenges in providing quality of care is poor infrastructure, According to Rural Health Statistics 2018, as of March 31, 2018, India had a shortfall of SC, PHC and CHC by 18%, 22% and 30% respectively. 66% of the Indian population lives in rural areas and is largely dependent on the public sector for their medical needs. Process assessment for the health service components has shown gaps and needs to improve service delivery process, especially adherence to service guidelines by providers. Lack of timely, quality, and convenient access to healthcare in the vicinity, compels them to travel long distances to seek care thus adding to out-of-pocket expenditure.

To address all the factors affecting poor coverage of maternal and child health, efforts ought to be directed towards leveraging existing capabilities to provide better quality of care and services to improve key priority indicators. Empowering front-line health workers, and potentially the mid-level healthcare providers, with knowledge- based technology solutions, such as Clinical Decision Support System, based on Indian Guidelines can serve as a job aid and provide manifold benefits. It will allow the care provider to administer care based on a standard treatment protocol while ensuring an appropriate triaging with seamless continuum of care; reduction of unnecessary intervention and inappropriate referrals; and, provision of pre-referral or definitive treatment at point of care.

There was an established need for localized clinical decision support, which has also been previously field- tested in cardio-vascular diseases. However, the need for transforming Standard Treatment Guidelines (STG) into active clinical decision support, including local dialects, to ensure adherence to STGs in maternal and child health, was yet to be fulfilled. The purpose of the study is to test the feasibility of Elsevier‘s ?Arezzo, with adapted Indian Standard Treatment Guidelines, used in public health care settings through a Pilot intervention.

Arezzo, owned by Elsevier, is an active clinical decision support (CDS) and pathway technology that empowers personalised care delivery at patient and population level, supports the authoring and execution of Level 3 "active" clinical guidelines that are made computer interpretable through Declarative Artificial Intelligence.

The study said that it can enable transformation of primary healthcare by implementing multiple, merged STGs at the point-of-care, where the frontline health workers (FHWs) will only see content relevant to the patient. The platform was envisaged to bridge some of the key gaps and challenges in effective healthcare delivery in the public healthcare delivery system of India including inadequate and inappropriate referrals from health outreach, knowledge gap in FHWs, non-availability of local language guidance for FHWs, lack of evidence-based primary health screening, inaccurate operational and clinical data for evaluation of compliance measures, and lack of health outreach information in the care pathway, which will be addressed by generating a unique pathway for a beneficiary which could be integrated with the electronic health record (EHR) in the future.

The study, focused on maternal and child health through STGs faced various challenges including the lack of harmonized and updated guidelines for most conditions, the presence of rather outdated guidelines, local-language translations, and lack of interest from the beneficiaries.


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