Hridyam initiative of Kerala

Hridyam is an unique initiative by Government of Kerala to support children with Congenital Heart Disease (CHD).

Government of Kerala as part of their Infant Mortality Rate (IMR) reduction strategy gives due importance to Congenital heart Disease Management viz, Detection of new cases at the earliest, pre surgical care, surgery and post surgical care. Department of Health and Family Welfare through National health Mission takes up major activities in institutions under Directorate of Health Services and Directorate of Medical education across Kerala. The strategy adopted is to improve the early detection of cases especially those critical congenial heart disease and offer the best timely treatment and treat pre surgical and post surgical complications in time with utmost care.

Congenital heart defects/ diseases (CHDs)

Congenital means that is born with. Congenital heart defects/ diseases (CHDs) are conditions that affects the heart’s shape or how it works, or both. Congenital heart defects happen because of incomplete or abnormal development of the fetus' heart during the very early weeks of pregnancy. CHDs are the most common types of birth defects, conditions that can cause problems in overall health, how the body develops, or in how the body works. Critical congenital heart disease (also called CCHD) is group of the seven most severe congenital heart defects. They may affect the shape of a baby’s heart, the way it works, or both. Babies with CCHD need treatment within the first few hours, days or months of life. Without treatment, CCHD can be deadly.

It is estimated that 8-9 in 1000 babies (hardly 1 percent or 4,000 babies) is born with a heart defect in Kerala each year. Out of this about 1,000 babies each year are born with CCHD. Experts opine that many heart defects don’t need immediate treatment or can be fixed easily. But some, like CCHD, can cause serious morbidity or death.

How it works

As per the present system planned under ‘hridyam’, cases shall be registered from any location through the website - http://hridyam.in/public/registration_basic.php by any target beneficiary. The case will be notified to concerned officials of the district where the child lives. During case registration, immediately on filling the basic information, the child will get an automatically generated unique register number which will be used as Case Number for the particular case. On getting alert on case registration, the district officials will check whether all forms are filled. On completion of registration (form submission and verification by district officials) the case will be categorised primarily into category 1, 2 or 3 and will be reflected in a dashboard.

Five Paediatric Cardiologist are identified across Kerala who will give the opinion on cases online reviewing the case findings, investigation reports including ECHO findings as video and seeing the patients directly in case if the forwarded information is not sufficient. They will categorise cases based on the diagnosis, clinical condition and urgency to do the case as per the predefined categories. Category 1 (a-g), Category 2 A (1-3) primary and category 2B (1-3) staged procedures and category 3 Medical Follow up, so that surgery dates may be fixed by the institutions. They will give opinion on individual cases and forward the same to Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum or Medical College, Kottayam. These institutions will give surgery dates to individual cases as per the set protocol for each category.

In case if the paediatric cardiologist is unable to reach a conclusion based on the available data, the child will be called for a review and the district officials concerned will facilitate the same. Those cases clinically sick and severe will be put in the category 1a class automatically and this will be done by capturing six current clinical parameters. After categorising these cases, Paediatric cardiologist will forward all cases to SCTIMST or MCH Kottayam to get dates for surgery. They will review the cases, Diagnosis put by paediatric cardiologists, documents available, and will give dates which is the earliest for them. The system is set in such a way that these institutions can give dates which are within the timeline specified under categorisation and the dates starts from Date of Birth (DoB).

If the allotted dates are beyond the permitted dates, cases will be automatically referred to empanelled hospitals. All empanelled hospitals have individual login ids and they can see all the documents and reports so that they can allot the slots which are the earliest for them. All the empanelled hospitals will provide dates for any single case and the selection of facility will be based on the choice of family. This process will be visible to district officials and State level admin. District officials will facilitate the process of referral to Empanelled hospitals by coordinating with the family that includes getting the choice of family to go to which facility. Based on all these procedures state level admin will give a preauthorisation to the empanelled hospitals to take up the case with them.

Important links

1. Online Case registration by citizens
2. Fetal Heart Screening Registration by Doctors

Source : Hridayam website