Pregnant Women in Tamil Nadu Depend on Handwritten Notebooks as Digital Health Records Lag
In Chennai, expectant mothers at the Government Women and Children Hospital in Egmore are frequently seen queuing up, clutching a small but indispensable document—a notebook that accompanies them through months of prenatal check-ups. This notebook serves as their primary medical record, documenting everything from scan details and prescriptions to doctors' notes, often acting as the only consistent record across hospital departments.
Digital Gaps in a Tech-Driven System
All pregnant women in Tamil Nadu are registered on the Pregnancy and Infant Cohort Monitoring and Evaluation (PICME) portal, which records basic patient information. However, diagnoses, prescriptions, scans, and laboratory results at government hospitals are still recorded manually in these patient notebooks. This practice makes key medical details, including comorbidities, digitally inaccessible if the notebook is lost, creating a significant risk for continuity of care.
Patients report that doctors rely entirely on these notebooks to prepare case sheets. "They note down my weight and blood pressure during every visit," said P Indumathi, who is in her third trimester. "I bring it for every check-up. I don't know what will happen if it's lost," she added, expressing concern over the lack of backup.
Challenges and Warnings from Healthcare Staff
Across hospital wards, nurses can often be heard warning patients and attendants that safeguarding the notebook is their responsibility. "It has details of vaccinations, blood test results, and scan interpretations," explained A Gowri, a woman attending her routine check-up. "Government hospitals must have an online backup. If doctors retain the notebook, even our family members can't see it," she noted, highlighting that many patients struggle to read handwritten notes due to literacy or clarity issues.
Doctors and nurses attribute the slow digitization to a shortage of staff and limited infrastructure. "Internet connectivity is crucial. We need dedicated data entry operators before the system can work effectively," said Dr T Vinitha, an assistant professor at the hospital.
Infrastructure and Accessibility Hurdles
The hospital currently does not issue standardized antenatal forms, leading to variability in record-keeping. "Patients may bring any 80-page notebook. We issue outpatient slips, and the OP number—once generated in the system—is written in the notebook and sealed," Dr Vinitha explained. This ad-hoc approach underscores the challenges in transitioning to a fully digital system.
Doctors argue that the current method has its advantages, particularly for marginalized patients. Many expectant mothers visiting government hospitals remain on the margins of the digital system, depending on hospital staff to register their pregnancies on the PICME portal or the state's THAIMAI app, said hospital director Dr C Sumathi. "Many of our patients don't have smartphones or reliable internet. We can't leave them behind," she emphasized, pointing to the need for inclusive healthcare solutions that bridge the digital divide.
This reliance on physical notebooks highlights broader issues in healthcare digitization in Tamil Nadu, where technological advancements must balance with accessibility to ensure no patient is excluded from essential medical services.
