Government of India’s National eHealth Authority (NeHA) will accelerate adoption of electronic health records (EHR) of patients. It will provide a well-connected ICT platform that can inter-operate across healthcare providers, both in public and private sectors, without compromising on patients’ confidentiality, informs Jitendra Arora, Director (eHealth), MoHFW, in a tete-a-tete with Prathiba Raju
What will be the role of NeHA?
Why is NeHA essential?
Various regulatory aspects like privacy, security, access, disclosure and exchange will be taken care of by the proposed NeHA. Every country, during the adoption of national e-health strategy, has focussed on developing an authority or agency that would take care of key regulatory and promotional issues. It is necessary to maintain privacy and confidentiality of patients’ health records. The National Knowledge Commission (NKC) in 2009 had recommended for the establishment of a National Health Information Authority (NHIA) to maintain the flow of information between various healthcare establishments and provide guidelines in the context of maintenance and use of EHR. NeHA will map the landscape of eHealth. It will monitor and evaluate eHealth uptake in the country and also increase the involvement of states by promoting to set up state health record repositories and health information exchanges.
What are the focus areas outlined under Digital India Programme for health?
Digital India Programme prepared by the Ministry of Electronics and IT covers in its ambit the use of ICT in healthcare. The programme envisages online medical consultation, online medical records, online medicine supply and pan-India exchange of patient information.
Can you tell us about the latest measures on eHealth by MoHFW?
The Union Health Ministry has been progressively using ICT under the overall objective of Digital India programme. We are working in the direction of citizen empowerment through information dissemination. A host of online services have been launched. These include National Health Portal (NHP) for one-stop authentic health information to citizens and ORS – the portal for getting online hospital appointment and test reports (http://ors.gov.in/), which is running successfully in AIIMS Delhi.
Potential use of mobile technology is also being harnessed in several ways for strengthening and widening the reach of various services as well as increasing citizen participation through various mobile apps viz. Indradhanush immunisation programme, monitoring and reporting of dengue; Swasth Bharat and mobile health initiatives like tobacco cessation, mDiabetes; mHealth initiatives like Kilkari, mobile academy and ANMOL (ANM online) -IVR-based services for parents of children and frontline health workers.
What are the key problems and challenges faced by the current eHealth system in India?
The main problem and challenge we face is the compartmentalised approach. Take any IT system, they work in silos. The other issue is of data duplication, maintenance of multiple registers, delay and errors in data entry due to manual processes.
What is MoHFW’s vision for eHealth?
MoHFW has envisaged establishing a system for interoperable EHRs of citizens, which will be created, made available online and would facilitate patients with better health outcome, affordability and decision support system. To set up a robust EHR system, one of the key requirements is implementation of EHR Standard-compliant Hospital Information System (HIS) in all the hospitals, healthcare facilities and setting up of an Integrated Health Information Platform (IHIP).
What is the status of HIS in public healthcare facilities?
As far as roll out of HIS is concerned, NIC team at Tripura has already developed cloud compatible ‘eHospital’ application, which is compliant with EHR standards. All the central government hospitals, AIIMS pan India and other autonomous hospitals under the health ministry are implementing e-Hospital in a time bound manner. All the states and UTs have been requested to adopt EHR standards in all e-health applications and implement eHospital application. No hospital has so far introduced EHR standards fully, although a few hospitals have worked on it partially. So far, Tamil Nadu and Gujarat have already implemented HIS solutions developed by TCS in public health facilities. Haryana and Kerala have awarded contract to private vendors for implementation of EHR compliant Hospital Management Information System (HMIS) in their states.
What are the current challenges in adopting EHR standards?
There is a need to standardise EHR maintained by different hospitals, to ensure that these records are shared across other clinical establishments. Therefore, the ministry has decided to implement the standards for seamless information flow and smooth movement of health records of beneficiaries across hospitals.
The Indian healthcare system being diverse, ranging from private, corporate and large public hospitals to single doctor clinics, throws up huge challenges in adoption and implementation of EHR standards. However, while recommending the EHR standards, due consideration was given to ensure that these standards are implementable with ease by public hospitals, corporate hospitals of various sizes, diagnostic centres as well as small rural public healthcare facilities and establishments. Doctors and other service providers need to adjust their work flow in order to incorporate EHR use, and also to use the information gained for continuous improvement of healthcare delivery.
Implementation of EHR improves clinicians’ decision-making by providing access to patient health record information when they need it. It also streamlines the clinician’s workflow, cuts delays, plugs gaps in care, helps in reducing medical errors and ensures rationalisation of treatment and avoidance of duplication of investigations.
When did MoHFW notified the EHR standards and why is it being revised now?
The EHR standards were notified by the government in September 2013 after wide consultation with domain experts and stakeholders. We also placed the revised draft in public domain till March 2016 and sought comments/ views. More than 100 comments were received from various stakeholders including general public. EHR review committee members have reviewed these comments and updated the revised EHR standards for India 2016 document. EHR standards is a living document required to be updated every two years due to change in advancement in technologies and global standards and therefore it is currently under revision. The updated version will be notified shortly.
Which clinical standards has been adopted in the notified EHR Standards?
EHR standards include Systematised Nomenclature of Medicine Clinical Terms (SNOMED CT) which provide a consistent terminology across all healthcare domains. This allows clinicians to communicate effectively and accurately across clinical domains and over the lifetime of a patient record.
How can IT vendors and hospitals get the SNOMED CT licence in India?
To obtain a country licence, India has become a member of International Health Terminology Standards Development Organisation (IHTSDO) in April 2014, which owns and administers the rights to SNOMED-CT by paying membership fee every year. Presently, 28 countries are members of this organisation. Vendors can use SNOMED-CT Standards of IHTSDO ‘free of cost’ to develop various EHR products for use in India.
SNOMED CT is available for usage in the country, however, understanding SNOMED CT and its implementation for its adoption is important. The Union Health Ministry has designated C-DAC, Pune as interim National Release Centre (iNRC) for distributing and managing SNOMED CT license within India.
What is the current situation on protecting health data privacy in India?
In India, a statute specifically protecting health data privacy does not exist. Health legislation in India is specific to certain health conditions including mental or physical illness, disability, communicable diseases and HIV/ AIDS; and covers some privacy aspects.
The MoHFW has assigned drafting of Electronic Health Data Privacy, Confidential and Security of India Act work to ‘National Law School of India University (NLSIU)’ and a first draft is ready. The ‘substantive part’ of the law is regarding confidentiality, privacy, ownership of health data and establishment of NeHA.
How will the government implement eHospital application of NIC in a time-bound manner across the country?
To facilitate eHospital implementation, we have empanelled private vendors from nine regions who will assist states in the roll-out of e-Hospital. They will help hospitals in identifying the ICT infrastructure gaps, software configuration, functionality and imparting training. Manpower for hand-holding can also be hired through these empanelled vendors for any length of term depending upon the requirement of different hospitals. For smooth implementation, the MoHFW has framed implementation guidelines elaborating various steps to be followed with a defined timeline. Roll out of EHR will be in phases and is targeted to be complete by 2020.
How do you plan to achieve interoperability between health IT systems?
The ministry has envisaged setting up of an Integrated Health Information Platform (IHIP) for interoperability between health IT systems. IHIP is expected to address various key issues and challenges for different stakeholder groups such as fragmented information systems, accessibility and quality of data, duplication of data collection – data redundancy, sub-optimal resource utilisation— due to duplicate information systems, and most importantly, owing to the lack of common EHR system.
How will the proposed IHIP help patients and citizens?
Today, most of the patient records have a decentralised storage, and get trapped in multiple healthcare facilities such as primary care, specialists, hospitals, pharmacy, home healthcare etc. IHIP will work to enable the EHRs of citizens to be made available nationwide with the help of a centralised accessible platform. It will facilitate continuity of care, confidential and secure health data or records management, better affordability, optimal information exchange to support better health outcomes, better decision support system, fewer redundancies and medical errors, low data redundancy, big data analytics etc.