Category: EHR Standards

Categories
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

Categories
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.

Categories
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.

Categories
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.

Categories
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.

Categories
EHR Standards News & Events

New Government Schemes & initiatives indicate a very important role for IT in Healthcare in India. Are your ready for the future?

Reviewing the role of Information Technology (IT) in healthcare in India, we could say that we have not been successful in achieving the fullest of our potential. We still lack the enabling role of information and communication systems in healthcare to optimize wellness management in India. If we are to look deeper, we are yet to integrate the marvels of modern communication devices and technology with Indic medication and wellness practices like Yoga, Ayurveda and Naturopathy for enhanced and personalized treatments.

However, the proposed tech-integrated initiatives from the Government of India such as Indian EHR standards, Digital Information Security in Healthcare Act (DISHA), Mental Healthcare Act 2017(NMHA) and National Health Policy 2017 appears to change things for good and arrive as a welcoming change in the healthcare sector. The Chief Information Officer of Asian Institute of Medical Sciences shared his thoughts to Elets News Network on the tech integration with medical facilities. Here, we have summarized the excerpts for you.

Mr. Lakshman shares that one of the most notable initiatives with respect to technology in healthcare has been the Electronic Health Records. In initiatives such as E-health, the Information Communication Technology (ICU) is used to deliver better healthcare to a wider audience through efficient monitoring and achieve better availability and affordability of healthcare.

He notes that the penetration of mobile devices and internet connectivity has surged over the couple of years and this is an advantage for technology to make health records of patients available through messages, call or web-based services. The scheme comes with an intention to pave way for the accessibility of online health records, health consultation, medicine supply-chain management and patient information exchange. The Indian Government intends to roll out a unified way to manage and provide health information to hospitals, clinics and wellness practitioners in the country.

He added that the creation of an integrated health information exchange is to strengthen the development of standards compliant electronic health records for Indian citizens and ensure interoperability of the records across the country. The benefits of such an exchange include reduced expenses on healthcare, increased health reporting, reduced paperwork, better and customized wellness agendas and treatments, pan-Indian accessibility of health data, seamless deployment of healthcare services and more.

Mr. Lakshman also brought out the role of Ayurveda, Naturopathy, Yoga and other alternative medicines in Indian healthcare. He stated that there has been a paradigm shift in the way healthcare and wellness is perceived. With increased stress due to work, current lifestyle and lack of exercise, there is a dire need for better and optimized healthcare services in India. Today, it is not just about curative treatment agendas but preventive wellness practices. That is where AYUSH comes into action.

AyushEHR from HealtheLife

At HealtheLife, we believe that it we can pave way for better health and wellness agendas for patients and individuals by integrating electronic health records with AYUSH practices. More than being an alternative medicine, AYUSH can help in the better diagnosis and treatment of ailments and diseases with the integration to individuals’ electronic health records.

Spas, wellness resorts, Ayurveda and Naturopathy clinics can now make use of patient data to offer better treatments and offer tailored patient care. With the government recognizing the role of electronic health records and coming up with tech integration schemes, it would be the right time to leverage the potential of electronic health records for AYUSH wellness practices using AyushEHR. Talk to us to know how we can help you.