Home Isolation Tracking (HIT) Covid App: Technological Innovation by Bihar Government

Introduction

In April 2021, as the second wave of COVID-19 began in India, Bihar had 100,000 active cases.¹ The geographical distribution of the COVID-19 positive cases in Bihar showed that 60 percent of the total cases were in the rural parts of the state.² Officials reported that the number of rural cases in the state was nearly 10 times higher in the second wave than the first wave.¹ In such a situation, experts expressed concern about the poor infrastructure in the rural parts of the state, which could result in higher casualties.²

To address the high number of COVID-19 cases and low institutional capacity for quarantine in rural areas, the state advised home isolation for all suspected and confirmed patients. Realizing that the condition of home-isolated COVID-19 positive patients could suddenly deteriorate, the Bihar government planned and executed a scheme to monitor their vitals and respond rapidly to serious cases. 

The Bihar State Electronics Development Corporation (BELTRON) collaborated with the state’s health and IT departments to develop an innovative home-isolation tracking technology in just five days. The Home Isolation Tracker (HIT) Covid app monitors the condition of COVID-19 patients recuperating at home. A pilot test of the HIT app launched in May 2021 in five districts. It has since been scaled up for adoption across the state.^3,4  

What are the lessons learned from this bright spot? 

Although home isolation reduced the pressure on Bihar’s health care infrastructure, a shortage of oxygen was the major cause of death in India during the second wave of COVID-19.⁷ Bihar recognized the importance of monitoring individuals under home quarantine in a regular manner. As a result, the HIT Covid app was designed specifically to track the progress of patients by keeping a daily record of temperature and blood oxygen levels.³ The success of the application was driven by two key factors. 

Use data strategically for decision making

The HIT Covid app allowed for better patient management because the captured data was flowing in two directions simultaneously: top-down from the district authorities and bottom-up from the health care workers (see Fig: 1).⁴

The district authorities kept the list of all COVID-positive patients updated on the app. State authorities then used this data to allocate patients to rural health care workers for surveying. This ensured that all patients who needed to be isolated were being monitored and could be responded to in case of emergencies.⁴

All health care workers on the ground updated the app with temperature and blood oxygen level of all patients. In case of emergencies, such as when the percentage of oxygen falls below 94 percent, the workers sought medical assistance for the COVID-19 patients from the nearest authorities.⁵ In such cases, the authorities admitted the patients to COVID-19 wards or ICUs, depending on their condition. Because the data were collected daily, the government built a more realistic understanding of the on-ground situation and better managed demand for oxygen cylinders and beds. Keeping track of the growing demand also ensured better resource utilization of the limited resources in the state. 

Fig 1: Flow of Data

Leverage the existing network of frontline workers

ASHA, ANM, and other rural health care workers played a crucial role in managing the spread of the virus in the remote parts of India.⁸ Several states including Uttar Pradesh, Rajasthan, and Maharashtra involved their health care workers in rural areas to undertake COVID management-related activities such as contact tracing.^9,10 Using Bihar’s HIT Covid app, these frontline workers efficiently monitored COVID-19 patients in home isolation. Each health care worker checked in with a specific group of home-isolated patients. Monitoring, done at the district level reduced the burden on the workforce and the human error associated with manual allotment and follow-ups.^11,12

How was this promising practice implemented?

When the app’s pilot went live, one Bihar nodal officer was appointed per district, along with special teams of health care workers who monitored the condition of individuals in home isolation.¹³

Conduct comprehensive training program

The state undertook a mass training program to build the capacity of 95,000 health care workers for collecting and recording data.³ All districts were provided with user manuals⁴ and other necessary details about the app. The health care workers also received a walk-through of the app. Once fully trained, they went door-to-door and conducted surveys of COVID patients in home isolation.³

Record and transmit health data

When health care workers recorded oxygen levels and temperature for each patient, the HIT app transferred the data to health department officials. Based on close observation, the health department officials decided on a case-by-case basis whether patients needed hospitalization, oxygen support, or ICU beds for proper treatment.⁴ If the oxygen level of the patient dropped below 94 degrees, or any other signs of deterioration in health emerged, the health department made immediate and appropriate arrangements with COVID care centers or hospitals.⁵

Conduct a pilot before expanding

The application was piloted in five districts and then scaled across the state. Over five days in mid-May 2021, trained health workers tested the app in Supaul, Aurangabad, Bhagalpur, Gopalganj, and Nalanda.⁵ During the pilot, 1,000 people were tracked in the five districts. Of this pilot population, 95.2 percent reported normal levels of oxygen while 2.3 percent (approximately 23 patients) had oxygen levels between 90 to 94 degrees. Of these 23, the app alerted state authorities to 12 patients who needed immediate attention, based on the seriousness of their condition.⁴ This process allowed the patients battling COVID-19 most severely to receive more advanced care at the earliest moment.

Supplementary material

Home Isolation Tracking (HIT) Covid App - Technological Innovation by Bihar Government.pdf

Sources

1. Nag D. Coronavirus second wave in Bihar: Surge in COVID-19 cases! Figures from rural districts surpass last year’s peak. Financial Express. Published April 30, 2021 .  Accessed August 12, 2021. https://www.financialexpress.com/lifestyle/health/coronavirus-second-wave-in-bihar-surge-in-covid-19-cases-figures-from-rural-districts-surpass-last-years-peak/2243108/ 

2. Rajawat KY. Bihar Is Effective In Battling Second Wave Of Covid-19: Health Minister Mangal Pandey. Moneycontrol Policy Talk podcast. June 3, 2021.  Accessed August 12, 2021. https://www.moneycontrol.com/news/podcast/policy-talk-bihar-is-effective-in-battling-second-wave-of-covid-19-health-minister-mangal-pandey-6983051.html 

3. HIT Covid: An app for patients at home in Bihar that impresses PM Modi. Livemint. Published May 20, 2021. Accessed August 12, 2021. https://www.livemint.com/news/india/bihars-hit-covid-app-for-patients-at-home-pm-modi-seeks-details-for-countrywide-use-11621483434368.html 

4. Jha DK. Bihar to track Covid +ve in homes with AI. The Pioneer. May 18, 2021. Accessed August 12, 2021. https://www.dailypioneer.com/2021/india/bihar-to-track-covid--ve-in-homes-with-ai.html 

5. Bihar chief minister Nitish Kumar launches app to monitor Covid patients at home. Times of India. May 18, 2021. Accessed August 12, 2021. https://timesofindia.indiatimes.com/city/patna/cm-launches-app-to-monitor-covid-patients-at-home/articleshow/82719190.cms?utm_source=contentofinterest&utm_medium=text&utm_campaign=cppst 

6. Government of Bihar. HIT COVID. Home Isolation Tracking Application. https://hitcovid.bihar.gov.in/ 

7. Covid-19: India outrage over 'no oxygen shortage death data' claim. BBC News. July 2021. Accessed October 19, 2021. https://www.bbc.com/news/world-asia-india-57911638 

8. Ghosh A.  India’s all-women frontline defence against COVID-19 are now locked into a fight for fair pay. Gal Dem. Published July 07, 2021. Accessed August 12, 2021. https://gal-dem.com/india-asha-women-healthcare-workers-fight-for-fair-pay/ 

9. India Today Web Desk. Overworked, underpaid: Asha workers, the frontline warriors in rural UP's Covid battle, Ground Report. India Today. Published May 13, 2021. Accessed August 12, 2021. https://www.indiatoday.in/coronavirus-outbreak/story/uttar-pradesh-rural-corona-asha-anganwadi-anm-nurses-underpaid-1802310-2021-05-13 

10. ASHA Workers Played Critical Role In COVID-19 Management In Uttar Pradesh, Tracked 30.43 Lakh Migrant Returnees. Swachch India NDTV. Published July 1, 2021. Accessed August 12, 2021. https://swachhindia.ndtv.com/asha-workers-played-critical-role-in-covid-19-management-in-up-tracked-30-43-lakh-migrant-returnees-46495/ 

11. Impressed with Bihar's HIT COVID App, PM Narendra Modi seeks details for countrywide use. The New Indian Express. Published May 19, 2021. Accessed August 12, 2021 https://www.newindianexpress.com/nation/2021/may/19/impressed-with-bihars-hit-covid-app-pm-narendra-modi-seeks-details-for-countrywide-use-2304710.html 

12. PM Narendra Modi Praised And Instructed To Use Bihar Government HIT App In Whole Country. Accessed January 28, 2022. https://www.google.com/url?q=https://www.bhaskar.com/local/bihar/news/pm-narendra-modi-praised-and-instructed-to-use-bihar-government-hit-app-in-whole-country-128505962.html&sa=D&source=docs&ust=1645753753166914&usg=AOvVaw1F3F--pedReDZGhDZcgqzM 

13. After successful run of 'Vaccine Express' in rural areas, Bihar launches it for cities. Economic Times–India Times. June 3, 2021.  https://economictimes.indiatimes.com/news/india/after-successful-run-of-vaccine-express-in-rural-areas-bihar-launches-it-for-cities/articleshow/83202579.cms