These are interesting times for Indiaâs eGovernance, in general, and the countryâs eHealth, in particular, says Vinay Venu, Technical Architect, ThoughtWorks, BangaloreÂ
Over the last couple of years, we have witnessed the governmentâs concerted effort to standardise data, metadata, communication protocols and processes in the health sector. Looking back at the Mini Timeline of eHealth initiatives:
Interesting times indeed! While EHR adoption in India is still catching up, we have several international national eHealth system use case scenarios to learn from. We are perfectly poised to take stock, clarify our direction and start building the right information systems for the India of tomorrow.
This is where we have to remember that the end state we hope to achieve is Utopian and the ask is Herculean.
With EHRs installed at every point of care and exchanging data via Health Information Exchanges, the benefit to stakeholders is huge. Medical records are not lost. They are no longer in silos, each with a different healthcare provider. Doctors have a better insight into the patientâs history. This helps the former take better decisions. Test results are not misplaced.
The implementation of universal coverage becomes much easier. Public health programmes are betterÂ focused and more effective with the availability of rich and more accurate data. The list could go on. And for all these benefits to see the light of day, there are challenges to be met and compromises to be made.
Apart from the usual technical laundry list of challenges like handling deduplication, legacy data, security, scale, usability and more, there are perhaps a few just as if notÂ more important factors to deal with. A successful national eHealth system needs sufficient electricity and network connectivity, which means it has to be much better than it is now.
We plan to use Aadhar cards to identify people in the proposed new national eHealth system. However, around 27 per cent of the country still needs to get their Aadhar cards done. The current concept note to create NeHA mentions inter-agency cooperation. How well cooperation is achieved will decide the success of the programme.
One of the biggest compromises would be eating into doctorsâ time. In a country where the doctor to patient ratio is already skewed, providing additional responsibilities to doctors will definitely affect the care provided.
However, as it is imperative that solutions like the Electronic Health Record (EHR) not affect patient care, the EHR systems need to be more robust, tactical remedies likeÂ implementing transcription could help. Apart from this, judicious consideration of how much data is collected might be required. Add to this a long term vision of increasing the number of practicing doctors (by building more medical colleges) and we have the makings of a solution.
Keeping Everyone Happy
No easy task especially when stakeholder requirements are in conflict.
Here is an example, today, most health data collection happens at theÂ aggregate level this makes it easier to collect and maintain. Most policy decisions are based on such data. However, while tactical decisions can maximise the systemâsâ utility, unless detailed patient records are collected, the system is in fact ignoring patients.
Taking the right steps to ensure an excellent healthcare system for our and future generations also means taking bold steps towards that future
What would help, here is makingÂ the complex decision of how much data is enough for a clinician to capture. And this is a hard decision what is better for patient care, is it more data at the cost of a doctorâs time or an incomplete patient record. Here, answers are not simple to find and such decisions are taken based on experience. Keeping the programâs end goal. Bringing a smile to the patientâs face, in mind ensures the right decisions are taken.
And what makes these tough decisions worth it? That, in these times of data driven decisions,Â relevant data analyses performed for public policy be part of the public domain as open data. Taking the right steps to ensure an excellent healthcare system for our and future generations also means taking bold, confident and careful steps towards that future.