A digital informatics application is as good as its underlying processes and people. Even if the application is built on a best-in-class digital architecture, if the underlying people and processes don’t have checks and balances in place, it is bound to fail. Learn more from this post on what the authors intend to convey on implementing best practices in health informatics.
The buzz words within the health care ecosystem are ‘health informatics, digital health, and m-health applications.’ In the 21st-century healthcare industry witnessed an unprecedented increase in the field of informatics owing to the rapid digitalization of records, internet coverage, reduced cost of smartphones and data. The ongoing pandemic too prompted an increase in policy support required for implementing and scaling up these applications.
Digital healthcare in India has been a growing avenue of innovation and focused investments in past few years. Many mobile health applications, which are trying to solve the challenge of demand-supply mismatch (healthcare appointments, telemedicine, digitizing health information etc.) are riding on the wave of growing smartphone and internet penetration.(1, 2)
Government of India also undertook some digital initiatives on the wake of this pandemic by creating a mobile app – “Aarogya Setu” to do effective contact tracing, and now “CoWIN” to enable the vaccination drive. But in the race to digitize, we have lost the purpose to do so. Though applications like ‘CoWIN’ and ‘Aarogya Setu’ were implemented to foster participatory surveillance, adherence to COVID appropriate behaviour and ease the vaccine registration process, but soon encountered challenges which defeated the whole purpose. Few state governments like Maharashtra(3) which has proposed and Assam have come up with their own applications(4) adding to the confusion!
Some lessons offered through these experiences are:
When a critical health application is designed, it is expected to have a high user demand (concurrent users). It should be well-built and backed up with digital and network infrastructure to handle the demand. But we witnessed challenges of using these apps, not limited to app getting crashed when the portal was open for age groups 18 and above (contradicting evidence available), facilities (providing vaccines) not visible to book slots and the toll-free helpline numbers being busy forever.(5, 6)
No doubt, this is an ambitious project by Government of India, but it fails to address one of the most important problem – access. Only 42% Indians have access to a smartphone (FY 2020),(2) which makes these digital assets virtually unreachable for rest of the population. Many DIY activities and information fails to reach the vulnerable population due to this wide digital inequity leading to overcrowding of health facilities and lack of a streamlined process for patient population management in these difficult times.(7)
A digital informatics application is as good as its underlying processes and people. Even if the application is built on a best-in-class digital architecture, if the underlying people and processes don’t have checks and balances in place, it is bound to fail. Classic example of such failure is to understand the sociotechnical interaction of these informatics application which was highlighted by the BBMP war-room incident, where a sitting Member of Parliament unearthed extensive interference by employees leading to bed shortage in the city, thus highlighting that “informatics applications are only as good as it’s developers and implementors are”.(8) Applications can deliver desired results only if it is automated with limited manual intervention along with robust governance (authorization and reporting) policies.
Follow Continuous Improvement
As the application adoption is increasing by the day, it is always a need to collect user feedback and improve the application architecture and infrastructure. Catering to a vast population is a challenge and technology can only enable it, and if it is overwhelmed to deliver during crisis, going back to papers is effective!
There is also a need to solve the user-level challenges encountered to complete in-app workflows. Passive periodic evaluations must be carried out to understand the pulse of end-users. Use of social media posts for performing sentimental analysis and accepting feedback in the pursuit of social good is need of the hour. The proverb of “numbers don’t lie” seldom holds true for population informatics applications.
Build Health Services Network and Communication Channels
No digital health application can be a stand-alone silver bullet. We should go beyond that to strive for digital inclusion and providing last mile health services to those who cannot rely on these applications owing to low digital literacy, limited access to smartphones and ability to use these applications. It is imperative to conduct usability studies, employing a combination of approaches such as using volunteers to support the online registration, reducing the spread of misinformation by reaching to those who are catalysing these efforts and sustaining the diffusion of innovations using well informed strategies.
In conclusion, we suggest that researchers synthesize evidence on failed informatics applications by considering the context so that there are lessons offered at individual, community, and systems levels to bring out what (not) to do while implementing an application. Academic journals should open their lens to publishing these kinds of literature than restricting themselves to publishing only success tales!
Fragmented health information platforms have been a historical issue to Indian public health system and allowing independent apps for every state would only make this data aggregation and health communication exercise a decorated issue. Use of voice support to guide end-users in navigating through the portal can improve the experience. Engaging with the regional health facilities on a daily basis can further ease the bottleneck that occurs at the facilities because people stop flocking unnecessarily in front of the hospitals if there is no vaccine stock.
1.Jacques Bughin JM, Jonathan Woetzel. Digital India: Technology to transform a connected nation2019. Available from: https://www.mckinsey.com/~/media/McKinsey/Business%20Functions/McKinsey%20Digital/Our%20Insights/Digital%20India%20Technology%20to%20transform%20a%20connected%20nation/MGI-Digital-India-Report-April-2019.pdf.
2.Statista. Smartphone penetration rate in India from financial year 2016 to 2020, with estimates until 2025. 2021.
3.PTI. Allow states to have own apps for COVID-19 vaccination: Maharashtra CM Uddhav Thackeray. The Economic Times. 2021.
4.Assam Govt. COVAAS 2021 [Available from: https://play.google.com/store/apps/details?id=in.nic.assam.covaas&hl=en_IN.
5.SENGUPTA A. CoWIN Chief Says App Didn’t Crash When Vaccine Registration Opened For All 18+ Indians: Report. 2021.
6.Shukla I. As Thousands Fail To Register Amid CoWin Site & App Crash, Twitter Successfully Launches Meme Fest 2021 [Available from: https://www.scoopwhoop.com/news/cowin-vaccine-registration-website-app-crash-twitter/.
7.Ravi Reddy RA. Coronavirus | Digital divide curbs vaccine access in rural Telangana. The Hindu. 2021.
8.PTI. Hospital bed scam: Searches conducted at BBMP Covid war rooms. Deccan Herald. 2021.
*Nachiket Gudi, The George Institute for Global Health, India
*Gaurav Pradhan, Consultant, Advisory, Healthcare & Digital