Dr Shiva Prasad is a busy man. A general practitioner, he attends multiple clinics throughout the day and sees a number of patients. On Sundays, he devotes his time to outreach clinics in rural areas around Bengaluru. He is the Medical Officer at Biocon Foundation’s eLAJ Smart Clinic at Hennagara village where he attends to patients 6 days a week. Besides the usual infectious diseases that he sees in the clinic such as respiratory and gastrointestinal tract infections, Dr Shiva Prasad conducts monthly camps. The most well attended camp is the non-communicable diseases (NCD) camp. The free lab tests and consultation offered in the clinic attract a large number of the rural population.

The eLAJ Smart Clinics consist of a health information system which integrates an electronic medical record with opportunistic screening for non-communicable diseases (NCDs) and laboratory services. The system has been implemented in three Biocon Foundation clinics in Bangalore and 15 Government of Karnataka Primary Health Centres across 5 districts and partially rolled out in 5 PHCs of 2 more districts. The aim is to improve the quality of health care by supporting clinicians through information technology and diagnostic facilities at the primary health care level – the point of first contact between communities and their health systems.

Dr Shiva Prasad finds the eLAJ system useful in many ways. “When the patient comes, all the data is there: past results, BP, prescriptions, disease condition, we get all the data. Normally in a clinic we cannot see the patient’s past diagnosis, but here I can see the past history with a click of a mouse. It helps because I can find out their chronic illnesses; whether they had some other diagnosis. If I can see past history then I can change the treatment modality as required. When a patient comes with a cough and fever, I can think of lower respiratory tract infection. If he comes with the same history later, I can change the antibiotics or go for higher evaluation rather than giving the same treatment again. Or if he comes with heartburn we think of gastritis but if he keeps coming we can refer to a higher centre for cardiac evaluation. So the past history on the eLAJ system is very helpful. In other centres, we can make out the diagnosis if it is written down but to know the prescription is difficult if the patient doesn’t bring the prescription. Then we might end up repeating the same treatment. In that way the eLaj system is very efficient.”

Dr Pakhi, the medical officer at the Huskur clinic pointed out the direct benefit of the medical record to the doctors themselves.

“It’s definitely useful in that it safeguards me. Anyone can go back and see what the measurements, diseases and treatment were.”

One of the key focus points of the eLAJ Smart clinics are NCDs – which includes hypertension, diabetes and cardiovascular diseases and their complications. These diseases are often hidden from the afflicted patients themselves. This contributes significantly to the burden of NCDs – they are the number one cause of death and morbidity in India. The symptoms of hypertension and diabetes mellitus can be mild, vague or sometimes completely absent while the disease process progresses towards a critical event. Hypertension has been labelled a “silent killer” because of the significant damage it does while remaining undetected in patients. Opportunistic screening of anyone who walks into a health centre has been identified as a key strategy to reveal disease process that are not felt by patients. This screening forms a vital part of patient care in eLAJ Smart clinics.

Dr Shivakumar points this out. “So many patients come with complaints of fever; elderly and even younger patients. Due to the opportunistic screening at the registration, we were able to detect hypertension and diabetes as well. After the screening result, I request them to come on consecutive days to check the readings. I then advise them to come for the monthly NCD clinics which provide a specific package of services tailored to NCD patients. The eLAJ workflow provides the ideal platform to diagnose diabetes and hypertension so that we can make an early diagnosis and start the right treatment.”