ECHS Smart Card Failure Story

India's First National Level SCOSTA Based Health Project : A Smart Card Failure Story

Various Schemes have been operational in India and the Government has been spending millions of Rupees on these schemes, but the benefits of these schemes do not reach the entitled beneficiaries to the desired extent. Various leakages of revenue, improper management of resources and overall mismanagement results into increased expenditure. Many of these problems can be resolved through appropriate use of Information Technology. Smart Card technologies and Biometrics can play a key role through proper system integration.

The ECHS Smart Card would be India's largest Nationwide Smart Card project covering the entire country. As quoted by the DG (ECHS), Lt. Gen. Vijay Dua, during the inauguration of the Smart Card project, 'the scheme would be larger and better than the French Health Scheme which also uses the

Smart Card'. Volume issuance from all the 13 regions has started, hardware and software for Central location, Regional centers and polyclinics has already been deployed. Remote polyclinics have already started providing services to Ex-servicemen. Smart cards play a pivotal role in the scheme.

Another first to the credit of this project is the use of national Smart Card Operating System Standard (SCOSTA) specified by NIC, Government of India. Although the standard has been defined for quite some time now, it could not be adopted for implementation of any project. ECHS smart card project adopted the SCOSTA standard from the pre tendering state itself. The use of this open standard would ensure interoperability, compliance of International Security and Quality standards, and more importantly vendor independence.

Ex Servicemen Central Health Scheme (ECHS) was authorized by the Government of India on 30 Dec 2002, and has been introduced from 01 April 2003. It is a publicly funded Medicare scheme for ex-servicemen and pensioners & their eligible dependants, and will provide comprehensive, quality treatment through out-patient treatment at 227 Polyclinics all over India, and in-patient hospitalization & treatment through Military Hospitals and out-sourced Civil Hospitals & Diagnostic Centers at all these 227 locations, which will be empanelled for the purpose. Treatment/hospitalization in Service Hospitals will be available to ECHS members, subject to availability of specialty, medical staff and bed space. The ECHS Scheme has brought in tremendous flexibility and empowerment for pensioners. In order to meet the vast requirements to manage and effectively operate the scheme, Ministry of Defence, Government of India felt the need of a 'smart', secure low cost media which could store/ update critical information. In fact the Scheme became operational as the 'smart card' could provide solutions to most of the concerns of the Government. The major needs which have been successfully addressed by the smart card solution includes the following;

Secure Identity card for the ex-servicemen and all the dependants who are entitled to avail the benefits of the scheme. The security of various processes is ensured through a combination of:

Key Management System

Biometric

Data communication Security
India's First National Level SCOSTA Based Health Project
Why The French Health Care System Should Be Replicated Everywhere
Earlier Blog Post
ECHS Smart Card reduced to a dummy

Comment: Due to lack of networking the smart card is just used as identity proof of an Veteran or his dependants. No database of medical records are created or updated. Stock Inventory and medical provisioning is not automated for exploiting the SMART Card.

ECHS: Doctors must be exhorted to maintain records

ECHS Doctors due to heavy rush of patients in the Polyclinic seldom maintain the detailed health records. Now doctors have the technology to assist them. A general practitioner sees patient for all ailments and hence must maintain communication with the patient. If a veteran comes to a doctor with symptoms such as loss of appetite and general disability, the doctor should conduct full investigation from head to toe and then prescribe medications and recommend suitable diet.

Doctors should not resort to intelligent guess work (on hit and trial basis) as a short cut and prescribe over two dozen medications with the fond hope that at least one of the drugs will act! This typically helps the uneducated who feel satisfied with over doze of medications. A good doctor is one who prescribes the right medicine to cure the sickness or disease and not certainly by guess work!

The medicines prescribed in ECHS for the old and elderly is generally a long list which takes the dispensing staff more hours to answer questions relating to multiple dosage and identification of drugs meant for which ailment.

Another is the language barrier. All notices are in English whereas hardly a few of the Veterans and dependents can read English. Notices should be preferably in the Mother tongue of the Veteran or in Hindi. Notices should be minimal and not to fill up the space of the Polyclinic as hardly anyone reads the routine orders which do not concern a veteran. Why overburden him with the bureaucratic style notices?

Contemporary Issue
Background: Bringing the doctors under the ambit of Consumer Protection Act has made an impact on doctor-patient relationship. There has been an increase in legal cases of medical negligence in the recent past. This article provides practical information on medical negligence.
Methods: Complaints received at Army Headquarters were studied to understand the factors involved in medical negligence.
Result: Various aspects of medical negligence including doctor-patient relationship in the military set up have been discussed.
Preliminary measures to be taken to avoid cases of negligence are enumerated.
Conclusion: Good communication skills to build a rapport with the patient is the key to avoid majority of the complaints. The doctor must pay due courtesy, respect and care to the patient besides maintaining medical records scrupulously.
Medical Negligence in Military Hospitals by Brig K Chauhan, Lt Col SM Perumal, Lt Col S Hiwale, Lt Col Rajkumar

CSD Canteens for ESM

Had a meeting with the QMG today. He is agreable to Exservicemen CSD canteens.
However there appear to be certain laid down conditions which have to be fulfilled:

The Station/ Area must have a minimum of 5000 Exservicemen card holders for an ESM CSD Canteen to come up.

As per govt orders ESM canteens cannot come up on A-1 Defence land. However if ESM get together and offer a room/ house/ any suitable place on their own, which they hire/purchase,then a case can be taken up for opening a ESM CSD canteen.

Regards honouring the smart cards is concerned , he has issued strict instructions that URC's not honouring the smart card will be cosidered for closure.

He has noted down the request for creating a site within the CSD website where CSD and DDGCS Army HQ can be contacted to record suggestions and complaints.

Also suggested to him to consider creating a site for helping CSD customers to buy AFD items online.
Lt Gen Jagdish Chander(Retd)
Head CSD Division IESM, Former DG ASC, Former Chairman CSD,INDIA)

ECHS: Parent Polyclinic?

Subject: Temporary Attachment Card ECHS
We have been receiving numerous complaints concerning the Temp Att Card required by Veterans who have to relocate temporarily to stations other than the Parent Polyclinic. Whereas we have in consultation with the ECHS been successful in working out a revised SOP regarding the TAC some doubts still remain. The Temp Att Cert (TAC) is reqd for issue of medicines for LONG durations. There is no other purpose.

We had prepared a proposal, but due to apprehensions of large scale uncontrolled sick reports (beneficiaries from peripheral areas) at polyclinics in NCR and in large cities, the proposal has been withheld. It was seen that there was a significant population that came to Chandigarh, for instance, to draw their medicines probably because the supply position there was better. One alternative proposal (to the one given below) is that for the first month only 7 days medicine will be issued at a time. After the first month when the revised load due to the new entrant has been catered for 30 days medicine can be issued as for all other dependants.

May I invite views from veterans ASAP. Please be brief and to the point. PLEASE DO NOT BE ABUSIVE OF THE ECHS no matter how dissatisfied you are.
Brig SC Kuthiala (Retd), Member ECHS Division IESM

Can ECHS resources cater to cure over 2 million PBOR's ailments?
If IESM is unable to get the problems of PBORS health care sorted out in a reasonable time frame then it should seriously consider taking legal opinion and with the help of Sainik Boards/ and State Governments, being a registered NGO to ensure these PBORs where health care cannot be arranged through ECHS/ Army then they should get proper health care cover from designated Civil Hospitals including Private from their respective States. But these should not be less then their entitlement. In any case it is best alternative for remote places.
Cdr Prem P Batra (Retd)
Apollo gets stiff dose from HC