EHR Standards Government Regulations

Towards a preventive and promotive healthcare driven by adoption of semantically inter-operable EHR

Interoperability of data is the foundation for advancing healthcare because, in today’s value-based market, availability of the required information is critical to making the right decisions. To do what’s best for patients, providers need to share critical information to help coordinate care across the entire continuum.

Every time a person visits a primary care provider (PCP), health information is being added to their own electronic health record (EHR). Where does that information go? The answer, currently, is nowhere, unless it is transcribed into a referral and sent to a specialist. And even then, it’s only partial information that is provided to the specialist – not the entire medical record.

There is no “shared care record.” Information about the individual exists in multiple EHRs, so no one has the complete picture of your health.

In 2004, United States created the Office of the National Coordinator for Health Information Technology (ONC) with the aim of introducing the notion that Health Information Technology (HIT) should be nationally coordinated. One of the first endeavors of ONC was the planning and design of a National Health Information Network (NHIN) as a means to facilitate the exchange of electronic health information among providers and Health Information Exchange (HIE) entities.

However, in spite of the above initiative, EHRs have largely remained siloed in their data repositories and have proven highly inefficient for sharing machine-processable information among providers caring for a patient. The real impact of digital information is yet to reach a level adequate to enrich patient care outcomes or greatly increase surgical decision making. Some EHR systems have been accused of data blocking and adding service costs for providers seeking more effective means of data sharing.

When digital systems seamlessly exchange data with each other, it is referred to as interoperability. More specifically, true interoperability occurs when information held in one EHR transfers through a standardized wire format to a separate EHR, in such a way that the information that is exchanged proves to be machine readable by the accepting EHR. Once that information is transferred, the receiving EHR should be capable of understanding the content and the context of the data shared for it to be able to represent the information appropriately in the workflow of the clinicians using the transferred information.

A clinical record can contain more than 100,000 different data fields and elements including numeric data, structured text, unstructured text and scanned files and images. To get these different systems talking to each other – exchanging data – context is critical. Without the correct context, medical professionals can overlook information.

From a usefulness perspective, there are three levels of interoperability:

  1. Foundational interoperability allows data exchange from one information technology system to be received by another and does not require the ability for the receiving information technology system to interpret the data.
  2. Structural interoperability is an intermediate level that defines the structure or format of data exchange where there is uniform movement of healthcare data from one system in a way that preserves and does not alter the clinical or operational purpose and meaning of the data.
  3. Semantic interoperability provides interoperability at the highest level – the ability of two or more systems or devices to exchange information and to use the information that has been exchanged. This level of interoperability supports the electronic exchange of patient summary information among caregivers and other authorized parties via disparate electronic health record (EHR) and other systems.

Interoperability of EHR supports collaboration between providers, which can reduce medical errors, misdiagnoses as well as repetitive, costly diagnostic tests. This is especially true for chronically ill patients who visit multiple physicians and specialists.

From a process improvement perspective, interoperability allows healthcare professionals to access data on specific populations of patients to develop best practices that are proven to improve outcome while controlling costs. When researchers pull clinical as well as financial data to evaluate treatment, outcomes and costs, they are better able to identify strategies to address gaps in care – which benefits patients, payers and healthcare organizations.

Challenges to achieving EHR interoperability

  • Lack of universal standards-based EHR system adoption
  • Impact on providers’ workflow.
  • Complex privacy and security challenges

Enablers that can improve the situation

  • Quality APIs that are based on industry standards
  • A cloud-based platform

One may assume that the interoperability efforts of the next several years will be shaped by pursuing the path that has guided the industry for the past several years: defining data standards, advancing the incentives that encourage exchange, ensuring privacy, certifying the interoperability capabilities of EHRs and addressing issues such as data blocking.

Deciding factors

  • Govt’s stand on deciding standards and regulatory bodies.
  • Adaptation of the medical industry towards changing technology
  • Proactive tech industry to building tools for medical industry

In the Electronic Health Record Standards for India, 2016, the government stated that ‘the prime aim of interoperability standards in India is to ensure syntactic (structural) and semantic (inherent meaning) interoperability of data amongst systems at all times.’ and it also ensures to provide care to the patients by optimal standards. With ths and other related policy initiatives, Indian government has demonstrated it’s commitment towards interoperability of EHR for it’s citzens.


EHR Standards Government Regulations Public Health

The challenges India is facing in adopting EHR widely to improve the level of public healthcare?

The Government of India is trying its best to improve the overall availability, accessibility & affordability of healthcare in the country. Over the past couple of years, it has implemented many policy initiatives such as EHR standards, National Health Policy 2017, National Metal Healthcare Act etc with the hope of making India’s healthcare impeccable. However, the industry is facing serious challenges to adopt EHR widely in their hospitals and medical establishments. Why is it so? Why isn’t the country able to quickly adopt technology to aid the transformation of healthcare in the country?

There are many factors that are obstructing the way of the progress that a wide adoption of EHR could make for the country’s overall health – Infrastructure, policies, impediments in research and resistance to new technology. While all of these are major challenges, the most prominent of them would be lack of basic infrastructure to support such a system. According to a recent report by the ministry of electronics and information technology, government hospitals and dispensaries have poor ICT infrastructure.

The problem is more prominent in India because we have mixed system of healthcare and all the players will have to come on board to make a difference. There are private medical establishments and there are public healthcare system run by the central and state governments, both running in parallel. Though EHR adoption has started gathering pace in the private sector, the public healthcare system is still facing difficulties to adopt technology, especially EHR. As the government healthcare establishments lack proper infrastructure the growth of digitizing medical records and the movement towards a technology driven operation has not been keeping ace with time.

From the less than 2% budget allocation for healthcare, India spends only 30% in improving the infrastructure in public hospitals and clinics. From this limited budget large portions go to supporting premier national institutes such as All India Institute of Medical Sciences(AIIMS) and Post Graduate Institute of Medical Education and Research (PGIMER), where you will find world class IT infrastructure such as computers and Internet connectivity, along with the resulting technology adoption. The lack of focus and concerted efforts by successive central state governments towards improving the standards of public healthcare have resulted in the low levels of modern technology adoption and the resultant quality of care delivery.

On the other hand, the private healthcare sector has grown multi fold, driven by large capital investments into digitizing their operations to improve quality of care and operational efficiencies. If India is to achieve it’s target of United Nations mandated Universal Health Coverage (UHC) by 2030, it needs to get inspired by countries like UK, Canada, Germany and Australia and update its traditional approach of low budgetary priority to healthcare.

The fact still remains that even when the private hospitals adopt EHR in their operations, the clinical information gathered is used to improve internal functioning of the hospital and is not shared with the patients or exchanged between hospitals. This is a sad state as the whole point of using EHR is getting lost. Electronic Health Record is efficient and widely used by other countries because of its standardization of information and interoperability. Here the hospitals are losing the essence of the philosophy.

If this is to change, the government has to put stern policies on the adoption and use of EHR throughout the country. It should incorporate EHR standards compliant software in public healthcare network to ensure that all the stakeholders – hospitals, patients, insurance companies, research establishments – are benefited.

Over the past few years, the government has been working hard to form a uniform policy framework to benefit every individual, irrespective of their level of ability to afford public or private healthcare. However, a lot more needs to be done if we are to achieve the high level of public health that every Indian citizen deserves, starting with investments into infrastructure and strict policy enforcement.

We at HealtheLife has been working on creating technology to help establishments adopt EHR economically and with minimal entry barriers. Our cloud based clinical information platform – EHR.Network – provides a solid base for anybody wanting to develop clinical applications. On the other hand AyushEHR, built on top of EHR.Network is a ready to use end-to-end software for Ayurveda, Yoga & Naturopathy resorts

Healthelife news

HealtheLife shares the details of our work to the visiting IT/BT officials from GoI & GoK.

Delegation of Government of India & Government of Karnataka IT-BT officials visited IIIT, Bangalore on 28th & 29th January 2019. Each session included 40+ delegates representing different states and central government and were visiting to understand the work happening in the Innovation Centre and also to interact & understand the Innovations being worked upon.

The meeting and presentation happened in MINRO Centre, Ramanujan Block. Apart from the presentations from research labs and centres of excellence at the college, HealtheLife, HyperReality & IOTRACX spoke about their work in the context of their spcial impact collaboration with the college.

HealtheLife shares the details of our work to the visiting IT/BT officials from GoI & GoK
Rupa Rao presenting on behalf of HealtheLife

Rupa rao and Dileep V S made presentations to the delegates on 28th and 29th respectively along with Divyaraj from Electronic Health Research Centre(EHRC@IIITB). The presentations focused on our research collaboration for the development of public use EHR platform and the Karnataka Mental health Management system.

Many of the delegates found the work happening in the Innovation centre of interest and were keen to know more. We are hoping to be given an opportunity to work with some of them later.

Healthelife news News & Events

HealtheLife & IIITB to jointly develop OpenEHR based EHR platform for public & research use

HealtheLife has signed a joint research project agreement with IIITB to develop a scalable Electronic Health Records(EHR) Platform for use in public health applications and research.

This project is part of an ongoing research project being carried out at the E-Health Research Centre(EHRC), IIITB which seeks to address existing concerns in the way ICT applications are being designed and developed in the Indian public health and nutrition sector.

This joint research involves the design and develop an Electronic Health Records & ICT application platform that can form the basis for a healthcare delivery system for the public health system. The proposed EHR Platform will have the following features

  • Management of patient demographics
  • Framework for management of patient health data across visits and locations, using an OpenEHR compliant implementation
  • Hierarchical management of health care establishments/organizations
  • Authentication and access control
  • Coding of health data using SNOMED CT

All the above features will be developed in line with the Indian EHR standards and relevant aspects of the Digital Information Security in Healthcare Act(DISHA).

The agreement is for 2 years and will use our EHR.Network platform as the base for the proposed research & development. Healthelife team will be working closely with the faculty members and researchers at IIITB on various aspects of the project under this agreement. Both the parties will hold joint IP for the developments that come out of this project.

The discussions towards this has been going on for more than 6 months and we feel that this agreement will help us enhance our capabilities and also give us a lot of visibility. We will find mention in all related PR activities of the college as well.

We thank EHRC@IIITB for endorsing our work for the past 30 months and acknowledging our domain competence.

Government Regulations News & Events Public Health

How Ayushman Bharat is expected to leverage technology and EHR software to deliver a high level of public health widely and economically?

Ayushman Bharat is the world’s largest health insurance program initiated by the Government of India. It is an ambitious project that will provide easy asses to healthcare for 500 million people of the country. It is an initiative to improve the primary healthcare in the country, especially for the underprivileged.

However, the program will reach the zenith of success only when the Government of India relies on modern technology to record, secure and share information to manage healthcare services and operations. Though it is a long way from now, tiny steps forward now can take this program to the next level. The world has realized this and have moved forward to digitize healthcare and it is now our turn to bring in technology and revolutionize healthcare in India.

Effective use of EHR

EHR came to India in 2013 with the Ministry of Health & Family Welfare (MoHFW) adopting the Indian EHR standards in September 2013. Since then, the idea has been improving and evolving in leaps and bounds. Now is the time to accept it completely and use it to amplify the Ayushman Bharat program. EHR enables the management of a patients’ records of his/her treatment and diagnosis digitally so that it is accessible to hospitals, clinics, labs and insurance companies throughout the patient’s lifetime. EHR enables the delivery of better care more economically and in the adoption of personalized and preventive healthcare practices.

Building ecosystem with EHR

Though EHR is the need of the hour, it faces many challenges to keep up with the vast and order-less state of the Indian healthcare system. To create a splendid future for Indian healthcare EHR needs to be adapted across private and public health care institutions. Other than in major cities, most of the population of India rely on public institutions for their healthcare needs and the whole public health system is hampered with the lack of adoption of EHR. In order to build an EHR based health ecosystem and make this program operational in a larger and better level, the public institutions also need to digitize their system and the government should play a prime role to make that happen.

EHR for privacy of information

Appropriate use of digital tools such as EHR is important even to secure data and privacy of the persons. EHR is a critical component of technology enabled healthcare as it is capable of providing privacy of clinical data and ensure that the data cannot be used by any health institution or establishment (Private or Public) without the consent of the patient. Every person has complete ownership over their clinical data and have the utmost authority to ensure that their clinical data and can be used only upon prior approval.

Ayushman Bharat is expected to leverage the proposed National Health Stack that is expected to create a framework that will interact with various health application programming interfaces within each system and transfer data from one another. It is an idea that could change the lives of large populations that are currently excluded from healthcare benefits of the existing ecosystem. If EHR and Ayushman Bharat program go hand in hand, it has astonishing potential to create wonders for people and in the medical sector of India.

We at HealtheLife have been working to create tools to make EHR adoption simple and painless. Our tools such as EHR.Network and AyushEHR are designed to help healthcare practitioners and establishments get on to the EHR adoption bandwagon and be prepared for Ayushman Bharat.

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When Kerala Government chooses Health as a Priority & implements the Clinical Establishments (Registration and Regulation) Act 2010

The healthcare crisis in India is a long unsolved story that needed much attention, until September 2018. Prime Minister Narendra Modi’s administration launched Ayushman Bharat, an initiative by the government to insure 500 million Indians. According to an Economic Times article, this program is supposed to be the ‘world’s biggest healthcare program’.

Amidst all this, Kerala government, under the Clinical Establishments (Registration and Regulation) Act 2010, has mandated the online registration of health institutions all over the state from 1st January 2019. It is a great proposition by the government to make healthcare institutions more patient centric and service focused. According to M/s KK Shailaja, Minister of Health and Social Justice, all health establishments in Kerala has to be registered into this online portal that holds information and records about the the facilities, capabilities & cost of medical treatments provided by the institutions.

It is such a progressive move by the state and promotes public welfare and health. After being the first state in India that declares to be having 100% literacy in 1991, Kerala has again proved to be one of the most rapid developing states in the country.

Objective of the Act

The prime objective of the Clinical Establishments (Registration and Regulation) Act 2010 is to establish a fair medical practice across India. This will not just improve the quality of healthcare, but also ensure one the minimum basic necessity of the common people. The Act will surely develop the medical and healthcare industry by gathering crucial data, information and statistical reports that are important for the establishment of future medicine and treatment.

With the opening of the registration portal, Kerala has become the first state to move forward with the implementation of this act.

Benefits to the Common citizen

Under this act , all medical practices including modern medicine, dentistry, Ayurveda, Yoga, Naturopathy, Homoeopathy, Siddha and Unani, in the public and private sectors are required to get registered. The only excluded clinical establishments are those owned, controlled or managed by the Armed Forces and those that provide only consultation services.

It is expected that people would get to know the facilities provided by the hospital, its cost, the qualifications of the doctors, the total count of staff members or paramedics in the center through the online portal. Now they can look, compare and choose hospitals or clinics by their own choice after browsing various institutions.

Strict actions against the offenders

It has also been said that impartial, strict actions would be taken against institutions which are not registered as mandated. In case of failure in uploading information on behalf of a health institution, it will be penalized and fined initially and eventually be shut down upon continuous violation of the act.

It is hoped to bring a revolution in the healthcare industry in the near future. Since Kerala is the first state to take such a vital step in the direction of a healthy change, it is expected to spread across the country and make treatments easy for the patients. It has already provided a new perspective to a bright new tomorrow.

More information on the bill and it’s implementation status are available at the Kerala government portal.

EHR Standards Knowledge

Indian Electronic Health Records(EHR) Standards – Part 4 : Shared clinical information models for semantic interoperability

In our series of Indian Electronic Health Records posts, the next aspect we intend to analyze is about shared clinical information models for semantic interoperability. One of the major purpose that healthcare information systems should serve is the optimum delivery of healthcare services and treatment programs. Since healthcare is not just a temporary event or happening but a perpetual affair that covers the entire lifespan of a person, the need to bring in interoperability standards for healthcare information systems becomes paramount.

Interoperability of data in IT systems works on two levels – syntactic and semantic. The former is transactional and is defined at the interface layer and often as an afterthought to exchange information between independently designed systems, whereas the latter is achieved at the design stage of software and ensures a more meaningful data exchange that includes both information and the context of the information. A true EHR system should not just do the former, but should be designed to deliver the latter

The Ministry of Health and Family Welfare(MOHFW) has taken a staged approach to enhance large scale adoption of the EHR technology, provide optimum security of health information, implement specifications, consider factors to improve interoperability and ensuring semantically interoperable EHR for Indian citizens. The Indian EHR standards includes pointers, such as OpenEHR, to the direction that the country is projected to move.

Since there are many clinical systems already in place, the first phase in pushing for EHR adoption is to define an exchange format and convert the proprietary data into that format as needed. Here the focus is on the applications and interface design, with no thought given to the underlying data. The second phase should be to standardize models for health data first and build new EHR systems on top to avoid interoperability issues completely and achieve semantic information exchange. This entails defining a shared set of clinical data models for newer EHR systems as the starting point.

As the pace of EHR adoption picks up, most healthcare organisations are beginning to realise that their data is more valuable than their applications. Since good data is key to improving outcomes, managing chronic disease and enabling population health management, it is becoming the key asset in their armory of tools. This key asset needs to be managed for the lifetime of the patient, when we all know that applications are not going to last that long. The question all of them are asking is ‘what happens to health data when we switch applications?’

The solution to the above problem is to turning the focus from applications to data. Imagine if the proposed National Health Stack for India builds on it’s common resources to include shared clinical information models that cover varied aspects of healthcare to support an Integrative healthcare paradigm. Imagine if instead of building applications, the government were to standardise models for health data? While it is unrealistic to expect that any application could cover the diverse requirements of healthcare, it would be possible to define a common set of clinical information models to support several different solutions. This would provide different stakeholders with choice of applications and vendors while at the same time delivering on the goal of making health data interoperable by design. It would also prevent vendor lock-in by making healthcare applications easier to interoperate and replace, while eliminating the high costs of data migration.

Our EHR.Network platform has been designed with this philosophy of shared clinical information models. It has been designed in line with the OpenEHR Reference Model and is designed to work with any OpenEHR Archetypes & Templates. Applications built on EHR.Network will remain future proof, portable and interoperable. We already incorporate a large number of clinical models from the International community governed Clinical Knowledge Manager(CKM). Apart from the cloud hosted public platform, we offer EHR.Network for collaboration and co-creation to build modern healthcare applications. Please contact us to know more.

Healthelife news News & Events Others

HealtheLife delivers keynote address in the 2nd user meet of NRCeS at AIIMS on 28th November 2018

The second user meet of the National Resource Centre for e-Health Standards(NRCeS) was held at All India Institute of Medical Sciences(AIIMS), New Delhi on 28th November 2018, Wednesday. The full day event was attended by Shri. Lav Agarwal, Joint Secretary, MoH&FW, healthcare and technology professionals from AIIIMS, representatives of many government & public sector organizations involved in eHealth standards implementation, large healthcare organizations and healthcare IT startups. The event was characterized by informative presentations, discussions and deliberations on different aspects of EHR standards adoption across the country.

The focus of this year’s event was the adoption and incorporation of SNOMED CT in clinical IT systems.

The major highlights of the day included the following

  • Key note address on the Role of Training & Implementation Support in Standard Adoption by Dr Karanvir Singh, Chief Medical Information Officer, Apollo Hospital New Delhi
  • Presenttaion on the Experience of Adoption and Use of Clinical Terminology at AIIMS, New Delhi by Dr. Sushil Kumar Meher & Dr. Vivek Gupta
  • Key note address on Standard enabled Analytics by Dr. Suman Bhusan Bhattacharyya, Founder & CEO at Bhattacharyyas Clinical Records Research & Informatics LLP
  • Key note address on the Need based Clinical Terminology Extension in Health IT system by Mr. Dileep V S, Founder HealtheLife Venture LLP

Along the course of the day, team members from NRCeS explained about the work being done by their team to support government departments, private organizations and healthcare IT companies to adopt EHR standards.

This event was of special importance to HealtheLife as we were invited to deliver a keynote address in recognition of the breathtaking work that we are doing in EHR.Network, our standards based open EHR platform and our pioneering effort in the adoption of EHR standards to Ayurveda, Yoga and Naturopathy through AyushEHR. The keynote address on ‘Need based Clinical Terminology Extension in Health IT system ‘ delivered by our co-founder Dileep V S was well received and generated a lot of discussions from the other participants. Many participants expressed interest in knowing more about our work in the future.

We thank Mr. Gaur Sunder, Joint Director & Chief Investigator, Ms. Manisha Mantri, Project Lead, Mr. Achyut Patil, Education and Training, Ms. Neetu Verma, NRCeS Promotion & Dissemination and other NRCeS Team members for the well organized and informative event and are looking forward to the next edition of the event.

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AyushEHR shortlisted for Round 2 of the National Bio Entrepreneurship Competition (NBEC) 2018

The excitement at HealtheLife continues.. We are excited about AyushEHR being selected to the Round 2 of the National Bio Entrepreneurship Competition (NBEC) 2018. This 2nd edition national level competition to identify breakthrough ideas in the areas of healthcare, agriculture, diagnostics & environment is being organized by BIRAC in partnership with C-CAMP.

The Bangalore leg of the event is scheduled for 12-13 November 2018 where we will be presenting our vision, of AyushEHR evolving into a game changing software for Ayurveda practice, to an eminent panel of experts & professionals.

HealtheLife team would like to thank all those who supported and helped us in our journey so far.

Ayurveda & EHR AyushEHR

AyushEHR- A game-changing software solution for the Ayurveda and Yoga resorts.

With the changing times and the heaps of work that needed for inter-departmental coordination, managing any industry is getting difficult. The need to collect, manage and interpret data from various business activities could only be done using pen and paper or through spreadsheet shared through google drive. But such methods have serious limitations that reduces efficiency and transparency of information.

What is ERP?

ERP or Enterprise Resource Planning is a business management software that organises, assembles and operates data from various business platforms and prevents unnecessary delays in processing information and mistakes. What started off as a tool for organising and scheduling of materials by the manufacturers initially didn’t cover all the aspects of the requirement in a company or firm. With the development and evolution of technology, ERPs have evolved into a unified and integrated approach for automating core business processes using a common database management system.

ERP provides many benefits to companies’ such as keeping track of the manufacturing, purchasing, sales and accounting and is a boon to the company management and senior stakeholders. But conventional ERPs, designed around manufacturing and services businesses, couldn’t cater much to the needs of the Healthcare Industry. Healthcare business has many special requirements such as maintaining updated patient information their medical history, medicine prescriptions etc. and so conventional ERPs fail to work properly. However Electronic Health Records(EHR) systems have been designed to address the specific needs of Healthcare industry.

EHR and its increasing use in the Healthcare Industry

EHR or Electronic Health Record is a digital platform used by the Medical Industry to manage medical and treatment history of the patients’ digitally and eliminate the use of pen and paper. What makes EHR different from ERP is its focus on the management of health information of individual patients by authorised healthcare providers. It may be shared with other providers across one or more medical institutions for the convenience of the patient and the medical practitioners and with laboratories, pharmacies, specialists or school and workplace clinics. Since the clinical record has been mandated as an belonging to the individual and his legal right, by the Indian EHR standards, EHR becomes an essential tool that supports the Healthcare industry to maintain compliance.

Philosophy of AyushEHR

With the increasing adoption of the philosophy of preventive healthcare using holistic wellness practices such as Ayurveda & Yoga, people all around the world are choosing to rely on the 5000-year-old natural healing process than popping pills to combat sickness and illness. Since the holistic approach of Ayurveda, Yoga and Naturopathy is quite different from the conventional field of medicine and treatment, such practitioners need to know the lifelong information about their patient’s medical background before initiating any treatment. They need to make tailored treatment for each of their patrons depending on their personal health history. AyushEHR has been designed with this in mind and is a software that allows complete accuracy and transparency in managing such personal health information. With the Resorts taking a lead in adopting technology for this traditional healthcare sector, many Ayurveda & Yoga Resorts already rely heavily on such EHR solutions to provide a personalized care for their guests.

Philosophy behind the creation of AyushEHR is to encourage healthy living. The cloud-based software is ready to use in personalized care management and is designed to improve the efficiency and effectiveness of business. It is a software package that enables healthy living, lifestyle and care. AyushEHR is the solution that makes loose ends meet, both from the doctor’s and the patient’s side.