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EHR Standards Government Regulations Public Health

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

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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EHR Standards Knowledge

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

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.

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Ayurveda & EHR AyushEHR

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

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.

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Ayurveda & EHR AyushEHR Yoga & EHR

Ayurveda and Modern Healthcare – Part 3: Opportunity to Reinvent & Rejuvenate to recapture lost ground

Ayurveda-Opportunity to Reinvent & Rejuvenate to recapture lost ground

Despite being one of the oldest and most credible medical practices in India, Ayurveda has resonance only among a limited percentage of population in the country. The comprehensive umbrella of AYUSH, which comprises of streams of treatment practices such as Ayurveda, Siddha, Unani and more are known for their effectiveness. However, the patronage of such Indic practices have been very feeble when compared to the Western practices like Allopathy.

An NSSO survey as recent as in the year 2015 reveals that over 90% of the population in both the rural and urban settlements in India preferred allopathy for diagnosis and treatment. The percentage of population that resorted to AYUSH was less than 7% in both the demographics. Though the trend would now be slightly better with the government pushing AYUSH adoption through its educational programs, institutes, wellness centres and regulations, the numbers would be just slightly higher.

The onset of Disruptive Technology

One of the major reasons allopathy has gained a very strong foothold across the globe is because of its adaptability. It has been evolutionary in its journey, adopting modern technologies and trends as they arrived. In recent times, allopathy was quick to adopt the cloud-based tech revolution – Electronic Health Records(EHR) – for its practice and wellness deliverance. With individuals’ medical data stored on the clouds, this ensured people from any part of the world received standardized treatment and diagnosis. Since the data is stored on the cloud, it allowed doctors and medical practitioners to retrieve the data and provide better and personalized healthcare services to patients.

Failure to catch up with technology

The reason for allopathy gaining traction is also the reason why Ayurveda couldn’t evolve as a popular healthcare practice. There are several factors Ayurveda can consider and work on to make it mainstream once again. Today, technology has evolved to an extent that virtual bots are able to detect the most minute presence of ailments in the human body that veteran doctors couldn’t spot. Since healthcare is an evidence-based service, we have diverse technologies today that work on gathering evidence through data.

With the record of patients’, doctors are now able to not just describe and prescribe medications and ailments but predict as well. The government has also come up with regulatory bodies, national policies and standards to benchmark the adoption of technology in healthcare and pave way for regularized, cost-effective and precise treatments.

Opportunity to Reinvent and Rejuvenate

Every new technology or concept has multiple aspects of adoption and Ayurveda has to improve technology adoption in its practices to gain more patronage. Ayurveda practitioners should work on three aspects of development to make the practices mainstream –

  • Build a supportive and sustainable ecosystem
  • Bring more transparency and record keeping
  • Understand and implement standards

Building an ecosystem means that the practitioners should look for more specific ways to adopt and leverage today’s technology. The use of EHR and clinical management systems in their resorts, retreats, clinics and hospitals is an ideal way to make the best out of tech and establish credibility among people and patients. Once the measures to generate, store, retrieve and share data are in place, the practitioners should focus on streamlining healthcare practices.

Patients gain trust on science when they are informed about the procedures and concept behind it. Ayurveda practitioners should aim to achieve the same through the use of EHR. A transparent treatment agenda will not just build trust but spread patronage as well. This treatment practice will further reflect on the outcomes of the practices in the fact that patients will be able to follow medications, therapies or remedies more judiciously.

With the onset of AyushEHR from HealtheLife, there cannot be a better time to kick start the evolutionary process for Ayurveda. Our cloud-based solution tackles any shortcoming your clinic or retreat is likely to face in terms of management and wellness deliverance. With the opportunity to reinvent and rejuvenate Ayurveda ripe, you can get in touch with us to leverage disruptive technology to grow fast.

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EHR Standards Knowledge

Indian Electronic Health Records (EHR) Standards – Part 5: Terminology and coding systems for meaningful clinical data

Terminology for meaningful health data

On part 4 of our Indian EHR standards series, we shed light on how the implementation of standardized information model would foster interoperability of data. Considering the diversity in health record systems, it would turn out to be tedious to attain semantic interoperability if there were no uniting terminology or coding systems standards in place. The absence of them would make the data captured ambiguous and open ended. Besides, it would also become difficult to automate processes and ensure that the data that is captured and stored is perpetually analyzable. That is one of the major reasons why terminology and coding standards are inevitable to attain meaningful clinical data.

In light of the above, any modern health record system should meet the following standards:

IHTSDO – SNOMED CT

The SNOMED CT or the SNOMED Clinical Terminology is the primary terminology library that India has adopted as part of it’s EHR standards. All electronic health records systems are expected to implement the SNOMED CT as their internal coding system to make the clinical data computable and interoperable. This clinical terminology includes all classes of clinically relevant terminologies including nursing, dental, drugs and substance related information. SNOMED CT should be used not just for transmitting clinical information to other health record systems but also for internal data capture, information storage and analysis as well.

Regenstrief Institute: Logical Observation Identifiers Names and Codes or LOINC

This code for Test Measurement and Observation, includes codes related to standardization of laboratory and imaging tests. They help in machine communication between diagnostic equipments and Clinical information systems, both for orders and results.

As pe the Indian EHR standards, at the point of data gathering SNOMED CT is recommended and the terms are transformed into respective LOINC for communication with diagnostic equipment. This enables effective internal data analysis as well us seamless communication with external systems.

WHO Classification Codes

World Health Organization(WHO) family of International classifications are used in statistical analysis and reporting of populations and public health analysis. They help analyze overall health trends in large populations such as a country and ethnicity. These codes are hierarchical in nature are not suitable for live data analysis in relation to real world situations.

These includes classification codes as follows:

  • ICD 10 – International Classification of Diseases and other derivative classifications
  • ICD 9 PCS – List of procedure codes
  • ICF – International Classification of Functioning, Disability and Health
  • ICHI – International Classification of Health Interventions
  • ICD-O – International Classification of Diseases for Oncology

In practical use, it is recommended that the data should always be gathered using SNOMED CT for finer granularity and flexibility in analysis. Later the data can be converted to the appropriate coding system appropriate mappings.

In summary, health records system are to use SNOMED CT for terminology and WHO family of codes for classification reports. The classification-based reports for regulatory purposes are to use WHO FIC codes as dictated by research bodies, intelligence or any health regulatory body.

So it is important to ensure that the EHR system that you are evaluating incorporates these coding systems for making the data semantically rich and computable. The person centric EHR platform form Healthelife – EHR.Network – supports all coding systems as per EHR standards. It also provides a built in terminology server for use by application while gathering clinical data.

To know more about EHR.Network, please contact us.

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Knowledge Mental Health

National Mental Healthcare Act 2017 – Part 1: Heralding a paradigm shift In the way we treat our mentally sick

National Mental Healthcare Act 2017

The much needed reform in mental health care diagnosis and treatment arrived a year back when the National Mental Healthcare Act 2017 was passed, by the Indian parliament, for better health care deliverance and treatment of individuals with mental illness. The bill revolutionizes health care for mentally sick and approaches their concerns and problems at grassroots levels. One of the major reasons for the passing of the bill was to ensure people with mental illness lead normal lives without getting subjected to discrimination or harassment.

Mental Illness As Defined By The Bill

To facilitate better health care, the bill first identifies the definition of mental illness. According to the bill, it is a disorder in individuals, wherein they are unable to think, perceive moods, orientations or have poor memory which ultimately influences their judgment, response, behavior, or ability to perceive reality. The bill also encompasses mental disabilities brought in due to abuse of alcohol or drugs.

While it attempts to define what mental illness is, the bill also specifically mentions what it isn’t an attempt to set any standards for defining health. As per the bill, mental sickness does not include mental retardation, which is characterized by an incomplete or arrested development of the mind.

What Does the Healthcare Bill Ensure?

The bill identifies several factors associated with the treatment of people with mental sickness and addresses each of them in detail. According to the Bill –

  • Every individual has the basic right to mental health care from clinics or centers funded by the government
  • It ensures free mental health care treatment for the homeless and those who live below the poverty line. The reassuring part is that the bill does not require a BPL card for their treatment and mental health care
  • The bill reassures that any person suffering from mental sickness has the right to confidentiality with respect to his or her mental illness or its treatment. No photograph or other personal information about the patient can be not released to media houses without acquiring a proper consent of the individual
  • The bill identifies several factors of discrimination such as gender, religion, sexual orientation, culture, race, class, disability, political beliefs and more and gives individuals the right to dignity
  • It also gives the right to the patient to initiate an advance directive regarding instructions to be followed by the care providers in case he/she loses the capability to make decisions. It also allows a person to nominate representative(s) to act on his/her behalf in such situations
  • Patients will not be required to undergo electro-convulsive treatment without the use of anesthesia or muscle relaxants. Further, minors will not be subject to such treatment at all
  • Patients will not be in any form or manner chained
  • Such individuals will be in solitary confinement only if deemed necessary for the safety of self or others

Additionally, the bill facilitates the establishment of a Central Mental Health Authority followed by a state-run State Mental Health Authorities. These authorities mandate all mental health institutions and mental health practitioners including nurses, psychiatrists and others to be registered with them and also have the final say in any providing care.

Duties of the Authorities

Once registered, it is the duty of the authoritative bodies to take care of the following responsibilities:

  • Register, maintain and supervise all health care institutions
  • Develop and maintain quality standards and norms for the operations of such institutions
  • Maintain a record of all mental health practitioners and professionals
  • Train mental health practitioners and law enforcers on the bill and its provisions
  • Be an advising body to the government on mental health cases

Further, the bill decriminalizes suicide, wherein individuals will not be charged under the Indian Penal Code for suicide. Instead, the government takes charge on providing better health care, treatment and facilitating a safe and stress-free environment for patients.

The incredible attention to detail given to the shortcomings faced by patients by the bill arrives as a welcome change. With this introduction, it is indeed a paradigm shift in the way we see and treat our patients suffering from mental sickness.

Healthelife has started working towards building capability in our EHR.Network platform to help care providers document and care for mental health patients in line with this initiative from the government. Please contact us to know more.

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Ayurveda & EHR Knowledge

Ayurveda and modern healthcare – Part 2: Role in the current health care ecosystem

Ayurveda and modern healthcare – Role in the current health care ecosystem

The heritage – traditional – way of treating ailments and diseases have been prevalent and practiced for over thousands of years in India. We come from a land where ideas about plastic surgeries were discussed and documented long before people across frontiers actually started thinking about such possibilities. Ayurveda is as much of a science as modern medicine and has been continuously evolving over centuries.

However, in the recent past, Ayurveda has been gradually replaced with other alternate forms of healthcare from the west. Despite being a holistic approach to wellness and treatment, cost effective and more holistic, Ayurveda has indeed lost a bit of its ground among the masses.

The reasons for this are aplenty. One of the major reasons has been the inability of Ayurveda and its practitioners to keep up with evolving technologies. While allopathy adapted continuously to technological advancements in terms of equipments, medications and care protocols, Ayurveda remained rooted to it’s traditional ways of treatment and approaches. There has been hardly any restructuring of the infrastructure with respect to technology or use of contemporary technologies to regain lost ground.

Ayurveda practitioners still largely depend upon the century old books and documentation for their practice as attempts at re validating these in the modern context has been minimal. The exploration into creating newer medicines and protocols and evolving the traditional ones to a modern world has not been well organized and widely practiced. Such efforts remain largely hindered, for lack of technology adoption and standardization in Ayurveda.

Ayurinfomatics or the use of information and data in Ayurveda still remains to be a huge hurdle for practitioners as they either don’t believe such practices could be indeed put into action or they don’t have adequate skills and resources to implement their tech-based visions into their Ayurveda clinics.

The Wake Up Call for Ayurveda

However, a more favorable and conducive environment is emerging in the country for Ayurveda and other traditional sciences. This is the ideal opportunity for Ayurveda to resurrect itself into the holistic wellness solution it was meant to be from the beginning. Today’s lifestyle dictate the need for a cost-effective, efficient and wellness focused treatment agendas and techniques. Besides, Ayurveda is both promotive and preventive, further making it the right health care solution for today. Contrary to the side effects of many allopathic medications, Ayurvedic treatments are complementary in nature and holistic in approach.

If we have to be honest, this is the time of aggressive marketing, where drugs and medicines from manufacturers are favored by medical practitioners and the credibility of them are being consistently overlooked. This is exactly what Ayurveda – with its herb-based medications and practices – helps us guard against.

The Challenges

For Ayurveda to become increasingly prominent among people today, it really has to step up its tech infrastructure. Most clinics and treatment centers still use registers for recording of patient details and paper-based prescriptions or medications. There are still no proper ways to track progress and the method of diagnosis is still old school. Ayurveda practitioners need to resolve a few basic challenges together by integrating modern technology into their work and leverage it’s capabilities. They should

  • Use computers in clinics, wellness centers and hospitals
  • Move to electronic health record systems(EHR)
  • Share records of patient information and health details for transparency
  • User data science to process and analyze data for better wellness deliverance and diagnosis

Implementing electronic health records(EHR) systems is one of the best ways to become on par with the competition because the records pave way for personalized health care treatments, more precise diagnosis of ailments, better tracking of patient information, remote retrieval of the information and more. By sharing EHR with your patients, you improve transparency and build long term trust and loyalty.

Government of India has also realized the importance of modern technology and information systems in health care and has come up with Electronic Health Records Standards for India. These standards analyze the diverse aspects of implementing technology and lay out regulations to be followed for uniformity and interoperability. This provides a great opportunity for Ayurveda practitioners to change their conventional working and operating model to adapt to emerging technologies for business and better treatments.

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EHR Standards Knowledge

Indian Electronic Health Records(EHR) Standards – Part 3: Security and Privacy guidelines in designing a Cloud EHR

EHR standards for security and privacy of health data

Discussions about privacy and security of personal data has been holding centre stage recently in light of the many high profile data theft and misuse of personal data that involves some of the most prominent technology companies in the world. With technology taking centre stage in almost all areas of human endeavour, countries across the world are racing against time to bring out regulations to safeguard personal data. The European GDPR is a case in point.

This is even more important in the case of intensely personal and private data such as EHR. EHR systems requires safeguards to ensure that the data is available when needed and that the information is not used, disclosed, accessed, altered, or deleted inappropriately while being stored or retrieved or transmitted. Given the pace at which technology adoption is evolving in healthcare, the only acceptable strategy for an enduring solution is to follow some basic design guidelines while designing EHR systems.

From the beginning the Indian EHR standards has made it point to treat data security and privacy as integral to the core of the standards. It attempts to do this through the following strategies:

  • Establish the person as the owner of their health data
  • Provide guidelines on the design of technology systems that manage EHR data to ensure that the data is inherently secure
  • Include administrative and physical access standards to protect the data falling into the hands of unauthorized users within an organisation

Ownership of EHR

By giving the person ownership of their EHR, the standard renders providers and any other agency holding EHR as only custodians of the data and thus limit the rights on the data. This reduces the chances of such agencies wilfully using anybody’s personal health data for purposes other than to provide care to the person.

The providers are also required to maintain the data in an interoperable format and make it available to the person in a pre-defined electronic form for use in future care situations.

Building security into the design of EHR systems

The standards include a wide range of recommendations to follow while designing EHR systems so that they remain inherently secure over a wide use case situations. At a generic level these include all the common security strategies employed by modern technology solutions including user authentication, authorization, access privileges, access control, automatic log-off, data encryption and transit data integrity. As these involve implementation specific strategies which are discussed in detail in many easily available articles, we will not be explaining them further in this post.

Apart from the above common domain agnostic guidelines, the Indian EHR standards include some guidelines which are very specific to the Healthcare domain. These are discussed in more detail below:

Segregation of personal and EHR data

The EHR standards recommends a complete segregation of the Demographic and EHR data in any EHR system. A person’s privacy in breached when a compromised EHR is identifiable as belonging to them. Any system where these data are managed separately and brought together as required in a usage context remains inherently secure. For such systems to be compromised, multiple services (a minimum of 3 including EHR, Demographics and Integration service) have to be compromised, making it difficult for an attacker.

Versioning of EHR data

Given the critical nature of health data, the standards mandate that health data should never deleted or destroyed completely. It further requires the systems to ensure that the older version of any data that has been modified are always available for review. The recommended strategy to address the above requirements is to version all EHR data. Any modifications to the data should create a newer version of the data, while all the previous versions are still maintained and available as required. Deletion of any data should create an new version with empty data set which co-exists with the previous versions. This ensures that the integrity of data is maintained and verifiable at all times.

Audit log

The Indian EHR standards require systems to maintain a detailed audit trail of all activities that happen. Such audit information should record date, time, record identification, user identification and the particulars of the action, whenever any electronic health information is created, modified, deleted or accessed(view & print). These should in turn be available to be electronically displayed or printed for user/administrative review. Further EHR information shared between organisations should contains sufficient identity information such that the receiver can make access control decisions and produce detailed and accurate security audit trails.

As you can see from the above privacy and security of health data is one of the cornerstones of the Indian EHR standards and provides a high level of guarantee to the end user regarding cloud based EHR solutions that are aligned to standards. Cloud based solutions now provide a very attractive option owing to their ease of access, lower cost and continuous improvement. Thanks to the Indian EHR standards, you now have a firm set of guidelines to ensure that the systems that you select are designed with security for your customers’ data.

Healthelife’s EHR.Network repository and AyushEHR are designed in line with the EHR standards and will continue to evolve with them. To know more about how we can help you get the best cloud EHR solution for your organisation, please contact us.

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EHR Standards Knowledge

Indian Electronic Health Records (EHR) Standards – Part2: Vision and Goals

EHR Standards for semantic inter-operability

The National Health Policy 2017, published by the Ministry of health and family welfare, outlines the goals of the Indian Government with respect to healthcare in India. The policy lays stress on the goal of attaining highest level of healthcare across demographics and to foster an environment of both promotive and preventive healthcare. It aims to eliminate any instance of hardship faced by people in receiving care or treatment in terms of financial or economic constraints. The report clearly indicates that this vision could be achieved through the following –

  • Increasing access to healthcare for individuals
  • lowering the costs involved in healthcare delivery
  • Improving the quality of healthcare

These three complementing factors invariably tie back to the need for electronic health records to make healthcare more efficient and cost-effective for both patients and clinicians/wellness practitioners. To make the process of deploying EHR streamlined and organized, the Ministry of Health and Family Welfare brought out the Electronic Health Record Standards for India in September 2013 and an updated version in December 2016.

The executive summary of the Indian EHR standards v2 states that “An Electronic Health Record (EHR) is a collection of various medical records that get generated during any clinical encounter or events. With rise of self-care and homecare devices and systems, nowadays meaningful healthcare data get generated 24×7 and also have long-term clinical relevance. The purpose of collecting medical records, as much as possible, are manifold – better and evidence based care, increasingly accurate and faster diagnosis that translates into better treatment at lower costs of care, avoid repeating unnecessary investigations, robust analytics including predictive analytics to support personalized care, improved health policy decisions based on better understanding of the underlying issues, etc., all translating into improved personal and public health.”

As you can see from the above, the standards brings out the importance of interoperability of health records for quick access to data and retrieval, as an when required, during the course of any person’s life. Further, the standards emphasizes the need for semantic and syntactic interoperability of data among all the systems involved in providing healthcare information.

Another primary goal of the EHR standard is to ensure the harmonisation of diverse healthcare practices and to integrate varied representation of healthcare information into a consistent one. It is expected that a unified information model can be viewed at from multiple angles and used with multiple vocabularies by organisations. To achieve optimum interoperability, the standardisation or mapping of diverse vocabularies is also envisaged.

Ensuring semantic interoperability using shared vocabulary for content exchange is one of the foremost goals of Electronic Health Records Standards. This is followed by goals such as –

  • Fostering technical innovation using the standards
  • Modifying, adapting, maintaining and helping in the evolution of the standards
  • Create an ecosystem where every stakeholder or vendor involves in the participation and adoption of the standards
  • Consider and evolve policies, frameworks, best practices and experiences of the standards
  • Maintain the cost of implementation at the lowest possible levels to ensure cost-effective deliverance of healthcare services and accessibility
  • Adapt modular and independent standards

In the absence of common standards, it becomes impossible to attempt the creation of a lifelong medical record, as records from ~80+ years, spread across different sources, needs to come together meaningfully. The vision and goal of Indian EHR standards is to create a set of pre-defined standards for clinical information capture, storage, retrieval, exchange, and analytics of different kinds of coded clinical information that includes images & other multimedia.

In the coming weeks, we will share more insights on the individual aspects of the standards for your easy understanding. You may either revisit these pages at weekly intervals or sign up for our monthly newsletter to know about them.

Further, if you would like to know more about how AyushEHR, enables Ayurveda, Yoga and Naturopathy practitioners integrate modern technology aligned to the Indian EHR standards into their practice, please let us know.

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Knowledge Yoga & EHR

Yoga and modern healthcare – Part 1 : Journey from ancient empirical wisdom to modern validated wellness science

Today, across India and also in many other countries across the world you can see people from diverse backgrounds practising and getting oriented to yoga. Over the past few years, yoga has become immensely popular around the world and it’s adoption has been increasing at an increasing pace. Through body postures and oneness exercises, yoga brings about progress and well-being not just physically but emotionally and spiritually as well.

It all started around 5000 years ago, where the first references of yoga have been found as palm-leaf inscriptions and oral knowledge passed over generations. Some researchers believe that yoga and the practice of it might have existed even earlier to that. Like many other spiritual and metaphysical ideas that has influenced human thinking across the world, yoga, again went from India to the West and came back more refined and aligned to modern scientific practices, as an effective solution to many of our physical and spiritual concerns.

When you try to trace the history and development of yoga, you can classify it’s history into four distinct eras.

Pre-classical Yoga

It was the region of Indus-Sarasvati, where one of the first instances of yoga developed. Rig Veda, which is considered to be the world’s oldest sacred text, had some of the earliest mentioning of yoga. Apart from songs, hymns, rituals and mantras saints, rishis and yogis practised yoga and documented their experiences in Upanishads. One of the most prominent scriptures of the Upanishads is the Bhagavat Gita, which laid the foundation of practice of ego sacrifice through action, wisdom and knowledge about oneself, talks about the inner struggle for self-mastery and the attainment of happiness through yoga.

Classical

After its earlier advent, there appeared to be a few contradictions and confusions among the yogic practices. It was not until the Classical era that the practices of yoga were standardised. Yoga was first given a systematic approach through Patanjali Yoga Sutras, which classified the practice of yoga into 8 stages. Each step gradually led towards Samadhi or ultimate enlightenment. The Patanjali yoga is regarded as the father of Yoga and is a major influence in modern day yogic practices.

Post-Classical

After the advent of Patanjali yoga, the rishis and saints formulated a concept of yoga practices that revolved around body and life force. Tantra yoga was developed as a way to cleanse the mind and body for the attainment of enlightenment. This deep exploration in the connection between mind and body that was started by tantra yoga – physical and spiritual nature – led to the development of Hatha yoga later.

Modern Era

It was the early 1900’s, that yoga began crossing international frontiers and barriers. Its healing and self-exploratory nature attracted immense following from people of other continents. Further it’s proponents and practitioners travelled, the more it gained patronage. The speech of Swami Vivekananda in Chicago at the 1893 Parliament of Religions was a critical turning point in the spread of yoga to the west. As far as Hatha yoga is concerned, the works of T.S Krishnamacharya was prominent. His contribution and popularisation of practices garnered mass attraction in the West and the spread of yoga achieved its peak when Indra Devi established a studio in 1947 in Hollywood.

Practice of yoga is on the cusp of another major revolution as it is getting integrated into all popular health and wellness practices. Such modern wellness solutions are information driven and use data gathered during it’s practice to continuously improve their effectiveness. It is now an accepted wisdom that you can impart better treatment agendas and wellness practices in your yoga retreat when you use modern technologies like Electronic Health Records(EHR) to combine problem diagnosis and treatments with other health data of the person. Further, a living science such as yoga, has to continuously use data generated during practice to validate its effectiveness, evolve better protocols and create a paradigm shift in healthcare to the management of holistic wellness.

To know how technology can bring about change in your yoga retreat, please read more about AyushEHR.