Summary

This project is launching a nurse practitioner-based comprehensive fixed-price health care system in Tamil Nadu. The venture will comprise a nurse-led primary healthcare facility offering diagnostics and outpatient care. A referral network will build a full healthcare continuum.

Program goals

To pilot an innovative organizational and financing mechanisms in the Thanjavur district of Tamil Nadu.

Key program components

The Integrated Rural Healthcare Pilot will operate through a hub and spoke model. The spokes will be comprised of 20 front-end health kiosks operated by general nurse midwives (GNMs). Doctors located at the hubs will manage both the network of kiosks and the upward referral network for secondary and tertiary care. The doctors will provide continuous assistance to the front-end GNM's through telemedicine, videoconferencing and coordination of regular visits by specialists. In addition to the doctors, the hub will also house a pharmacy and a diagnostic lab.

Health Kiosk

Each kiosk will be situated at the Village Panchayat Level with a population ranging from 6,000 to 10,000 people. Each unit (20 Kiosks) will have a catchment population of approximately 150,000 people. The health kiosks will cater to primary health care needs and preventive-promotive exercises.

Pharmacy

The hub and spoke model includes the centralized storage of pharmaceutical drugs, which will in turn support front-end inventories at the health kiosk managed by GNMs. The pharmacy will house over 100 generic drugs with high utilization for delivering primary health care. Drugs will be procured through a joint collaboration established with the Biocon Foundation and the Karuna Trust.

Electronic Health Records (EHR)

To implement the EHR system in the pilot site, the project has a collaboration with Yos Technologies, a Bangalore-based EHR provider. The data aggregated through this partnership will be shared jointly by the IKP Centre for Technologies in Public Health and Yos Technologies for statistical analysis governing the implementable curative as well as preventive-promotive interventions.

The project will work with the Financial Information Network Organization (FINO) to issue family-based smart cards to the clients, facilitating biometric identification (avoiding fraudulent activities) and storing primary health information. This smart-card can be used both at the kiosk level and the secondary network hospital level to link to the EHR of the given patient, avoiding duplication of tests performed, along with an appropriate medical assessment given an access to medical history of the client.

Telemedicine

The pilot will deploy ReMeDi's (Remote Medical Diagnostics) telemedicine device at the pilot site to connect the health kiosk for video-conferencing, consultation and real time diagnostics. ReMeDi can measure and transmit basic parameters such as temperature, blood pressure, pulse rate, 12 channel ECG, and oxygen saturation level and in the blood.