Tag: EHR Standards

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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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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?

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

Keynote address at EHR standards user meet, AIIMS, New Delhi

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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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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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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Healthelife news News & Events

The first National Resource Centre for EHR Standards(NRCeS) users’ meet showcases the increasing pace of EHR standards adoption in India

The NRCeS and CDAC organized the first Users’ meet for all the stakeholders and professionals working in the area of EHR standards adoption from across the country. The initiative was to bring together all the stakeholders to share their experiences with EHR standards adoption and create a platform to collaborate in the future.

The meet had a mix of representatives from the different sides of the adoption spectrum that included the government officials, doctors, hospitals, technology companies and professionals. The forum was an informal discussion where representatives from each of the areas presented details of their work, level and success in standards adoption and the problems that they are facing.

HealtheLife was represented by Dileep. The meeting was a very heartening experience as we realized that our understanding of the standards and the extent of adoption that we have been able to achieve puts us among the leaders. Among the large number of participants, HealtheLife was the only company working on standards adoption for healthcare practices other than Allopathy, which again makes us a pioneer innovating new use cases for EHR standards adoption.

The intent of the meet was for the CDAC and NRCeS representatives to collate the discussions and observations made by the participants and present to the Ministry of Health and Family Welfare(MOHFW) for their suitable action.

The meet had a very good attendance with participants travelling from all over India to be in Pune for the day and showed the commitment of the community in ensuring that EHR standards are adopted as per the vision of the Government of India. The meeting highlighted the high levels of enthusiasm and encouraging success so far and the long journey ahead for the community. We could learn some best practices that others have adopted and hope to use it to further improve the usability of our solutions.

Another takeaway from the meet was the initiatives that are happening under AYUSH ministry to create an Ayurveda extension to SNOMED CT and their commitment to bringing EHR standards adoption in the AYUSH Sector. This again validates the direction that HealtheLife has taken with AyushEHR.

As part of our commitment to this great community, we plan to publish a series of articles analysing the standards and explaining the key concepts in a simplified language that can be understood by a wider audience. Please come back once in a while to explore our blog.

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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.