Need of the Hour: India Needs to Implement a Nationwide Framework for the Adoption of EHRs

Indraprastha Apollo Hospital's remote tele-management of the patient during transportation
Indraprastha Apollo Hospital's remote tele-management of the patient during transportation

By: Mr. Vikram Thaploo, CEO- Telehealth, Apollo Hospitals Enterprises Limited

The main goal of the government is to Digitalise Healthcare

India, as a developing nation, faces the challenge of providing high-quality healthcare to its large and ever-growing population. To address this, the government is focusing on digitizing healthcare to ensure affordable access to treatment. The country’s efforts towards universal health coverage (UHC) revolve around the implementation of electronic health records (EHR). Recognizing the benefits of EHR systems, such as improved patient coordination, increased patient engagement, enhanced medical research, and reduced healthcare costs, India is gradually embracing their adoption.

Addressing EHR Standards: Promoting Secure Interoperability and Accessibility of Patient Records

The launch of the Pradhan Mantri Jan Arogya Yojana (PM-JAY) is a significant step in this direction. This program aims to offer INR 5,00,000 coverage for secondary and tertiary care to the bottom 40% of the population. Additionally, the establishment of approximately 1,50,000 health and wellness centers across the country, especially in rural areas, focuses on providing primary care. These initiatives have resulted in the regular collection of healthcare data for beneficiaries, prompting the government’s mandate to digitize these records and move closer to implementing EHR systems nationwide.

Status of EHR Adoption in India

In India, the adoption of EMR has grown in popularity during the past ten years. While the majority of private hospitals use an EMR system, public hospitals in rural and isolated areas struggle to gain access to the internet and still keep paper records. According to a study published by the Biomedical Journal of Scientific and Technical Research in 2021 involving 13 private hospitals and 2 government-run hospitals, only 8 out of the 13 hospitals were using the EMR system to record clinical data. They used this information for analysis, quality control, and to pinpoint areas in hospitals that needed improvement. The health information systems (HIS) in the other 5 EMR systems were utilised for billing and inventory control. EMRs improve the tracking of patient data. EMRs, however, are not intended to be shared outside of a specific practice, making it challenging to share EMRs with other medical facilities including labs, pharmacies and specialists.

Roadmap for the Adoption of EHR in India

The roadmap outlines several actions and activities that various stakeholders must undertake in order for EHR to be adopted nationally:

Basic ICT Infrastructure

Most public hospitals and dispensaries lack adequate ICT infrastructure. Only a few major public hospitals have connectivity and computers. The country has a sizable number of public healthcare facilities, necessitating a substantial investment in technology and software. Using open-source software platforms, mobile devices, and the cloud computing environment are required to cut costs. Every town will have broadband connectivity after the National Optical Fibre Network (NOFN) is put into place. When connectivity is available, remote villages can benefit from cloud-based healthcare delivery.

More Funding by the Government and Private Sector

The government plans to increase public health spending from 1.5 per cent of GDP in 2017 to 2.5 per cent of GDP by 2025, in accordance with the National Health Policy of 2017. The aim of 2.5 per cent should be aggressively pursued, with a focused budget allocation towards digitisation, along with attracting additional investment through favourable regulations and incentives.

Health Information Storage and Exchange Infrastructure

It is necessary for healthcare providers to exchange EHR. Using a master patient index, a health information exchange (HIE) locates patient data at other institutions, gathers the data for the patient, and documents the transaction for later audit. In order to respect the patient’s privacy needs, HIE is also in charge of authenticating the individual accessing the information. These exchanges must be set up and kept up by the government working with the private sector.

Personal Health Record System

The Personal Health Record System (PHR) can have a big impact on how EHR is adopted. PHR encourages the use of EHR since it saves the clinician from having to create the patient record from scratch. Basic data can be obtained immediately from the PHR, including demographics, immunisation information, known allergies, medical history and family medical history, test results, etc. The availability of PHRs, on the other hand, will allow patients to approach hospitals they have never been to before without having to worry about the interoperability problem.

Enforce Minimum Viable Standards

To address concerns regarding EHR standards, the Ministry of Health and Family Welfare (MoHFW) established the National Electronic Health Authority (NeHA) in 2015 and introduced the Digital Information Security in Healthcare Act (DISHA) in 2017. However, compliance with these requirements has been lacking, leading to concerns raised by stakeholders. To ensure that patient records are easily accessible, discoverable, and comprehensible, the MoHFW should adopt suitable global EHR standards, such as the Fast Healthcare Interoperability Resources (FHIR) standards, in line with international best practices. This will promote secure interoperability and streamline healthcare information management.

Protection of Privacy

Rules are necessary to increase patient and provider confidence when utilising e-health applications. Patients must be reassured that the privacy of their medical information will not be violated. Also, healthcare professionals need to be certain that the information they record won’t be changed without their knowledge. A role-based access system is required because there are many people participating in the treatment process.

Final Say

The government and the healthcare sector in India are aware of the numerous advantages of installing EHR systems. As a result, they are dedicated to widely implementing these systems. As of now, only the private health sector has adopted such methods. A concerted effort from all the stakeholders, including the Central Government, State Governments, healthcare providers, medical associations, the IT industry, etc., is required to increase the use of EHR.

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