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

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

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

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

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

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

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

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

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

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

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

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

Challenges to achieving EHR interoperability

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

Enablers that can improve the situation

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

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

Deciding factors

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

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

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EHR Standards Knowledge

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

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.