Table 1.

Health system needs and challenges and corresponding Components/Solutions of the I-TREC Model of Care

Health System Needs and Challenges	“I-TREC model of care” Components	Adaptations made for integration with GoI CPHC-NCD System
Supporting the healthcare providers in providing better care to the patients	Clinical Decision Support System (CDSS)	The CDSS for hypertension and diabetes has been integrated with GoI CPHC-NCD system to support the doctors in providing evidence-based care to patients at all the three essential steps of chronic disease management which are: screening, management, and follow-up. *a,b,c,d
Limited acceptance by doctors in using technology	Task-shifting to ensure the doctor spends time on the important tasks	The fulcrum of care (initial assessment of the patient during the health facility visit) has been shifted from the doctors to the nurse/non-physician healthcare provider. In the new workflow, a non-physician healthcare provider/nurse can do some of the tasks like using the technology solution to enter the details of the patients such as registration (if required), medical history, drug history, and measurements. *a,b,d
Patient referral	Strengthening the referral pathways	The CDSS-enabled GoI CPHC-NCD system has in-built referral thresholds based on the clinical parameters of the patients and level of health facility. It ensures the availability of the health record at different levels of care and sends the notifications of patient’s referral to the referred facilities. *a
Limited involvement of the non-physician healthcare workers in using the technology	Changes in the technology/GoI CPHC-NCD system for the better involvement of the non-physician healthcare workers	In the new version “CDSS-enabled GoI CPHC-NCD System”, the non-physician healthcare worker/nurse has got the access/permission to enter the details of the initial assessment (which can be vetted by a doctor). *b,c
Non-availability of hardware or limited time for doctors to use the technology	Addition of print-out functionality	In the CDSS-enabled GoI CPHC-NCD system, print-out functionality has been added. Through this functionality, a non-physician healthcare worker/nurse can take a print-out of the patient brief profile (which includes important findings of the current visit and previous visits) and CDSS recommendations. If a doctor is not using any computer/laptop/tablet because of limited resources or time constraint, he/she can review the profile and CDSS recommendations on the print-out. *b,c,d

Source of suggestions for these changes/additions

^aKey stakeholders’ suggestions

^bBased on previous research conducted by the investigators from the I-TREC team (reference # 8–16)

^cHealth facility assessment

^dLiterature