Table 3.

Challenges perceived by healthcare providers in referring out and receiving feedback through Nikshay portal about patients with TB at a medical college referral unit of Delhi, India

Themes	Codes	Verbatim
Awareness of programme and Nikshay	Low awareness about the programme	“As this is a medical college hospital, the patient load is very high. In addition, the doctors are also changing frequently due to which some patients are directly asked to visit their nearby health facility as they are not aware or forget due to high load of patients. But Nikshay ID has been created with us and we refer them without patients presence”
		“The information written in the treatment card is minimal for entering in our system and referring out. We sometimes go back to the doctor and fill the complete details though we are also busy with our own responsibility”
	Low awareness about the portal	“Initially, we were also confused what and where to enter in case of wrong address in the portal”
		“Though we were trained on Nikshay, the refresher training on the new portal is pending due to which we don’t know all the options available in the portal”
		“Sometimes, we are afraid to operate the technology”
		“No one teaches how to use the downloaded notification data”
Tracking of patients	Ascertain correct address and referral	“Patient provide local address of their relatives or wrong address. Confirmation of their address is a big task and it is consuming lot of time of ours”
		“Sometimes due to high load, we don’t reconfirm the address from the patient. We just take the address from the treatment card”
		“We see a lot of migrant population and it is quite difficult to ascertain their address and track them”
		“Through this (Nikshay) almost 90% of the referral feedback was received. Ten percent problem in getting feedback was due to wrong address being given by the patients”
	Duplication and hospital shopping	“Second time diagnosis of TB is not accepted by patients and mostly patients from nearby states visit here for diagnosis”
		“The STS of the referred out centre sometimes don’t provide feedback as the patient may be already diagnosed there and provided Nikshay”
		“Patients are getting diagnosed for TB from various departments both at inpatients and outpatients. Sometimes same patient is diagnosed for TB at different departments and started on treatment simultaneously”
User-friendly portal	Complicated and non-user-friendly portal	“Not able to operate in our tablet”
		“I have to fill the notification and treatment details which has to be filled by the STS”
		“We used to wait for hours to just open the portal in initial days. Now that issue has been sorted out”
	Multimodal use	“Can it be used in our mobile phone?”
		“It should be made more simpler to make me understand”
	Adoption of new technology	“Initially we used to get feedback through post or phone call. No one is taking feedback (now). At personal level, no one is doing this. Otherwise it will take time for full use of Niksahy”
	Instant intimation of new patient	“We get immediate message when we transfer money via internet banking. Why can’t we get a message like this”
		“Currently no message/information comes if patient is initiated on treatment; only the name gets deleted. There should be a message or mail sent which says that 8/10 of your patients have been received and started on treatment”
		“In the earlier version, a blinking message used to come everytime we open the portal which is not there in the current version”
Workload	Number of new initiatives	“There are lot of new initiatives like daily regimen, DBT, 99 DOTS, DST for all in recent days due to which we are getting less time for field”
	Reducing the backlog	“Nikshay is going good. Only thing is the backlog should be cleared”
		“Don’t burden us with the backlog and start all new initiatives from effective dates”