Can the Clinical Decision Support System Untangle the Difficulties in the Diabetes Management of Indian Tribes?

We have interestingly read the article by Pichardo-Lowden et al, which explains the role of clinical decision support (CDS) in diabetes management. ¹ The CDS can prove to be a revolutionary step in diabetes management in developing countries like India which has more than 1 billion patients with diabetes. ² Implementing CDS in India comes with its challenges as a huge portion of the population comprises tribes (8.6% of the total population, 10.43 crore people), and almost 90% of the tribal population lives in rural and far-flung areas, and have low socioeconomic status. ³ The remote residence in tribal settings lacks digital infrastructure with reliable Internet connectivity and the secluded residing area will also face logistical challenges to deploy the CDS system. The primary healthcare staff posted in tribal settings have limited technological literacy, to carry out the database. Moreover, patient engagement for any newer technology is also a challenging task, as the tribal population has low health literacy and their cultural practices make them rigid for their traditional remedies for the ailments.

The introduction of CDS can provide the tribal population quality treatment through the opinion of experts in the field which are not accessible to them locally. It can also provide awareness regarding diabetes and its complications as the knowledge about manifestations of diabetes-related ailments is very low in these areas. ⁴ The electronic health record–based CDS system in tribal settings can give a clearer picture of diabetes and related complications such as neuropathy, nephropathy, retinopathy, and diabetic foot ulcers. Various suggestions can be implied such as shifting to combination therapy from monotherapy if blood sugar is not controlled. ⁵ Dose adjustments and escalation of insulin can be maintained. It also ensures early diagnosis of complications, disability management, and prevention of further complications in these patients. The automated reminders and alerts from CDS systems can improve patient engagement and regular follow-ups. Personalized treatment plans can also be generated by the interface. These tools can also ensure adherence to the established clinical guidelines promoting standardized care.

To carry out the successful implementation of CDS in tribal settings, many factors need to be considered like the CDS needs to support multiple local languages to ensure effective communications to remove the language barriers. Also, the cultural sensitivity should be maintained. There should be specific training organized for primary health care staff of these locations in their local language and dialects about the basics and advances of the CDS system. A simple and user-friendly interface should be designed to maintain an electronic health record, which will be accessible to the healthcare staff but also ensure patient privacy and data protection (Figure 1). Moreover, the healthcare staff should be provided with tablets or other equivalent devices that give them reminders for follow-ups so that they can be communicated to the patients or their family members. The CDS systems can be integrated with telehealth solutions, extending the reach of healthcare services to remote areas. Tribal health can be benefited if the CDS system is incorporated into the National Digital Health Mission. The successful deployment of CDS could be challenging but the multifaceted approach of concerned (governmental or nongovernmental) authorities could maximize the favorable outcomes which can improve the quality of life in tribal settings.

Figure 1.

Effective implementation of clinical disease system (CDS) in tribal settings.