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.