CDST_LT: Nikshay The NTEP Information System

Nikshay being the final updated repository of information of TB patient services, different roles perform various actions on the patient and TB service information in Nikshay and keep it updated. These roles range from health volunteers and treatment supporters on the field to health providers and doctors at health facilities. Each role acts on or inputs information based on the services he/she provides. The information is required to updated when it is generated by the person generating it (eg by the CBNAAT LT once the results of a CBNAAT test is available). 

• Laboratory Technician (LT): This role encompasses LTs at all labs performing all types of TB related tests including those at District Microscopy Centre (DMCs), Cartridge Based Nucleic Acid Amplification Test (CBNAAT) and Culture and Drug Sensitivity Test (CDST) laboratories. The LT is responsible for  adding and updating test records (Test request and test result) in Nikshay that he/she performs. Nikshay in-turn provides the LT with the electronic register of tests performed at the PHI and also shares the updated information with other relevant stakeholders.
• Treatment Supporters and Health Volunteers: These field level volunteers (such as ASHAs) may enroll presumptive TB cases and refer them to the nearest PHI. Once a TB case is identified and linked to them for treatment support they can record and monitor TB patient adherence. Nikshay in-turn provides them with updated information of the patient and automatically calculates Treatment Supporters honorarium and enables its processing by the relevant authorities.
• Patients: Patients may view their updated TB health records including adherence information and status of DBT benefits processing in Nikshay through the TB Arogya Saathi Application. 
• Pharmacist/ Storekeeper: These ensure drug dispensation records of patients are updated along with related supply chain information in Nikshay and Nikshay Aushadhi.
• Health Staff: This is a group of roles posted to various PHIs(Peripheral Health Institutions) and their catchment geographies, ranging from CHOs and MPHWs to Medical officers of the PHI. They are responsible for ensuring that all records related to all patients in their catchment area, encompassing all functions from enrollment to post treatment follow-up. The Medical Officer/ Doctor in-charge apart from being the final accountable authority for ensuring updated and correct information is present in Nikshay, he/she needs to review and record treatment initiation (along with treatment regimen) and clinical decision in Nikshay with support from his/he health staff.
• Senior Treatment Supervisor (STS)/ Senior TB Lab Supervisor (STLS)/ TB Health Visitor: These roles train and support the above staff in ensuring that the information in Nikshay is up-to-date. They also review reports and coordinate feedback to the other staff to ensure optimum patient services.

The overall responsibility of ensuring completion of real-time updating of information/ data in Nikshay lies with the District TB Officer (DTO). The DTO is responsible for ensuring that the relevant staff are trained in the use of Nikshay.

Resources

• Training Modules for Programme Managers and Medical Officers.
• Direct Benefit Transfer Manual.

Assessment

Patient Identifiers are key for identifying a patient in the Nikshay. Ideally, there should be only one identifier for each patient which identifies patient as well as processes for lifetime. However, during the continuum of care, one identifier may not be appropriate to represent the episodes and other processes. Hence there are various ids which are tagged to one patient in Nikshay. Knowing each ID and its purpose is therefore important. The various IDs that are present in Nikshay and their purpose are described below:

1. Patient ID:  In Nikshay, a TB patient can be identified by their Name, Patient ID and Nikshay ID. Since, patients might get enrolled at one primary health institute (PHI), diagnosed at another and initiated on treatment at a different PHI, the ID has been simplified to a unique number. 
2. Episode ID: In a life cycle approach, a person needs to be tracked across episodes of TB known as the Episode ID. In the first episode, the Patient ID = Episode ID (will be numerically equal), the patient is notified and completes one treatment cycle (Diagnosis to outcome). However, the patient may continue to have TB or have TB again at a later point in time. This is recorded as a second notification and becomes the second Episode of TB. A patient may be identified in Nikshay using a global search by both Episode ID and Patient ID.
3. Test ID: When request for a laboratory test and test result for a patient is added under Nikshay, it generates a unique Test ID. For multiple tests added a new Test ID is generated for a patient.
4. Transfer ID: In Nikshay, a transfer request of patients between health facilities across the country feature is enabled. Users make requests of two types - “Transfer In” and “Transfer Out”. This process generates a unique Transfer ID for the patient. The details of Transfer In and Transfer Out with Transfer ID are available in Nikshay’s Transfer Management feature.
5. Sample ID: It is essential that patient samples are registered in Nikshay. While “Adding Test(s)” when sample details are added, Sample IDs are auto-generated. Sample IDs help to track samples in Nikshay using this unique ID.
6. Benefit ID: A “Benefit” defined in the Nikshay-PFMS (Public Finance Management System) is a payment due to a beneficiary under a particular scheme. For example, in Nikshay Poshan Yojana (TB Patient Nutritional Support Scheme), the beneficiary is a case of Tuberculosis, notified to Nikshay. This beneficiary under the scheme is eligible for Rs 500 for each treatment month. Thus Nikshay generates a Benefit ID that identifies the patient eligible for benefits @ Rs. 500 for each treatment month.
7. Beneficiary ID: A beneficiary is a person/ citizen who is eligible to get benefits (financial or in kind) under any government scheme. Whenever Nikshay identifies a potential beneficiary, it issues a unique beneficiary ID to it. All the benefits processed or paid to a beneficiary are tracked using the Nikshay Beneficiary ID. For example, if a patient has multiple episodes, all the benefits of the patient across episodes are managed using the Beneficiary ID. This information is available in the Beneficiary register exported from Nikshay.
8. Ayushman Bharat Health Account (ABHA) ID: The Ayushman Bharat Digital Mission (ABDM) aims to develop the backbone necessary to support the integrated digital health infrastructure of the country. Ayushman Bharat Health Account (ABHA) ID is a 14-digit number which can uniquely identify persons and authenticate them (previously known as Health ID). It can be used to access and digitally share one's health records, with consent. ABHA is integrated into Nikshay and addresses ABHA creation, capture and verification for seamless patient registration in Nikshay. Nikshay uses the Aadhaar verification services provided by NDHM (National Digital Health Mission) to generate ABHA.

Resources

• Nikshay-search for a patient, how to identify Nikshay ID/Patient ID, how to register a patient, Adding a new Episode, how to generate Test ID, Transfer Management, Sample ID generation_Diagnostics, Direct Benefit Transfer Manual, Training Video on Direct Benefit Transfer,  ABHA Workflow

Assessment:

Figure: Nikshay Home Page

After login in Nikshay, using the login credential shared by NTEP Health Staff, Treatment Supporter will be able to access the following button:

• New Enrolment: Allows to enrol new cases in Nikshay
• Search Patient: Allows to search for patients that are mapped to him /her, using Patient Name, Nikshay ID and Old Nikshay ID
• Add Patient Test: Allows to add tests for all the patients.
• Diagnosis Pending: View the list of the patients that are pending for diagnosis
• Not on Treatment: View the list of the patients that are diagnosed but pending to be initiated on treatment
• On Treatment Patients: Gives the list of on treatment patients
• Outcome assigned: Gives the list of the patients that have completed their treatment
• Training Material; Access the training content available on Nikshay
• Patient Summary: Gives a brief overview on the Presumptive cases registered, Diagnosed and patients that are initiated on treatment
• Task List: Allows to view the list of pending activities pertaining to adherence, Treatment Outcome and Bank details missing for mapped patient
• Latest Updates: New updates of features that are released on Nikshay

TB Aarogya Sathi empowers Citizens (including TB Patients under NTEP) and to serve as a Direct interface with the national TB program.

Citizen: The App is aimed at  increasing awareness among the citizens. It is available for all Citizens using the App (no login required to access this content)

• Information on TB (Symptoms, Side Effects)
• Health Facility Search
• BMI Assessment
• Nikshay Sampark Helpline
• Nutritional Advice

Patient: Patients registered with Nikshay will have access to the Adherence, Treatment Progress and DBT Details.

• Patients registered under Nikshay get access to their TB health record additional information (after login)
  • Adherence Details
  • Treatment Progress Details
  • DBT Details

TB Aarogya Sathi App is available in Google play store and can be download using this QR Code

Figure: TB Aarogya Sathi Application snapshot

Resources:

• Nikshay Training Material