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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.


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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

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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.