One of the challenges highlighted by NTP is the leveraging the data collected from the multiple sources into the main SITB system as a central warehouse for effective use.

The current SITB platform and infrastructure needs to be extended to support integration with external systems like TruNaat, Digital X-Ray outputs, digital adherence tools, Logistics management information system and Community-led monitoring systems like EMPATI as visioned by the national TB program with the concept of an integrated Health Information Management System (HMIS).

These data exchanges can be made seamless with API sharing between the platforms and the central repository.

Recommended data exchange/ ETL tools like Talend, Informatica ^{[6.1] , [6.2] , [6.3]} makes data management task much easier and simultaneously improves data warehousing. These exchange tools also comply with FHIR , GDPR standards for more secured and seamless data exchange supporting standard data taxonomy and meta data management processes.

Tentative timeline: Month 0-6

The main difficulty being faced by NTP is the challenge in data exchange without the presence of any unique identifiers in SITB. Data from multiple systems can only be integrated by mapping the various identifiers of a case across these systems.

It is recommended while capturing the information of the TB cases they should be linked with unique identifiers like national Id, ensure that duplication of the patient is avoided, and case is tracked, monitored and followed up throughout its treatment journey.

An alternate measure can be the generation of a unique code in SITB by combining multiple attributes from patient demographics and using the same for data exchange.

Tentative timeline: Month 0-1

The NTP’s plan clearly emphasizes on the importance and need for improving data use. This can be made possible by making more real time and useful case-based TB data across systems.

While there is an existing SITB dashboard there is a strong need to strengthen and expand the scope of data visualisation and making effective use of data for predictive modelling , data science and for advanced analytics. It is also recommended to use best of the breed tools like Tableau , Power BI ^{[7.1] , [7.2]} which offer these features. The current SITB platform offers APIs which can be connected for these applications and used as an extended analytical component of the data analysis framework.

Also , To ensure that there is a seamless data exchange from other platforms like WIFI TB and to support historical data upload from eTB Manager , the data should be extracted, transformed and loaded into the central database.

While SITB supports API other open source ETL tools over My SQL , Post Gres DB and / or WHO powered Xmart ^[8] which can be installed within the current environment can also be considered. HO Xmart :

Tentative timeline: Month 6-12

One of the challenges reported by the NTP during the assessment processes is inconsistent data connectivity / network issues which delays reporting of cases. One effective way to overcome this is to support the current data collection processes by introducing a mobile application, that has already been envisioned by the NTP team.

Other advantages for a mobile application include better performance , effective use of device features like in house system updates , usage of location , security measures and tracking user patterns and issue log mechanisms and other analytics measures.

Several mobile solutions for real time case-based notification can be explored for local adaption and building the mobile counterpart for SITB. Open source technologies like DHIS2 Mobile App, ODK and KOBO are some notable examples. ^{[9.1] , [9.2] , [9.3]}

Tentative timeline: Month 0-12

Based on the architecture, the system upgrade would be done with the database, a middleware system, the operating system or the hardware.

Additionally, the architecture should be such that it supports the integration layer which would be needed for data exchange with national/external systems.

The technologies that need to be brought in and the areas of inter-connection need special focus. A review of the existing server architecture is advised along with deployment of automated load testing tools like Selenium, Appium collection tools. ^{[11.1] , [11.2]} which can help in database sizing and monitoring adaptation needs for planning.

Tentative timeline: Month 6-24

To strengthen the current systems framework and ensuring long term sustenance, it is important to have regular evaluation of the security of the information and systems by measuring how well it conforms to an established set of criteria. This would also include developing a framework which should outline policies in line with recommended security standard policies for a) Patient data management, and b) server and infra guidelines.

Tentative timeline: Month 6-36

Planning for capacity building includes workforce assessment, ranging from ICT professionals to health workers providing care services. Since the application requires regular updates and adaptations, the system support team requires trained personnel on the technology stack in use.

Strengthening the NTP team with trained system administrators will help in improving and expediting the planned implementations.

Tentative timeline: Month 6-24

Auto generation of notification and messaging by the system through communication channels like Social Media, IVRS and SMS outbound messages should be explored. Open-source applications like Open MRS can be used for these activities ^[12] can be used for these activities.

Tentative timeline: Month 6-24