dWise Healthcare has taken the forefront role in upgrading the overall clinical efficiency of the hospitals by addressing each and every gaps within the system by integrating innovative features in the offerings to provide a holistic solution, shares Joseph Alexander, CEO, dWise Healthcare IT Solutions Pvt Ltd exclusively with Elets News Network (ENN)
What are the challenges of the adoption of electronic health record (EHR) systems in India?
EHR is about standards & code sets, and how health records and all clinical data of patients are electronically captured, stored & secured in health IT systems. It is also about ensuring interoperability, portability and availability of data to patients. Therefore, the onus is on the Government of India to define and publish these standards and also to ensure that the approved standards are in sync with international standards to ensure interoperability and portability of health records as patients move across nations.
The Government also has to mandate and regulate the use of these standards and further create bodies to validate and certify products from vendors on the compliance of standards. Fortunately, India has taken some important steps in this direction. In August 2013, the Ministry of Health and Family Welfare, Government of India published the Healthcare IT & EHR standards. The second version, the draft of which is already available in the public domain for feedback from various stakeholders, is expected soon.
In comparison to other advanced countries, especially the United States (US), the standards approved are minimalistic. However, it is a good beginning, considering the lack of advanced EHR systems in the country. Currently, only few solutions, likeLifetrenz EHR System, fully comply with the international and Indian standards. In March 2015, Government announced the formation of a regulatory body called the National eHealth Authority (NeHA), which is likely to be similar to Telecom Regulatory Authority of India (TRAI) for Telecom or Insurance Regulatory and Development Authority of India (IRDA), through an Act of Parliament, with the mandate to regulate and enforce adoption of the approved standards in the country.
Once NeHA is formed, the next big challenge would be to create a qualified and impartial certifying body to certify EHR products from vendors on the compliance of standards. Recently, KB Aggarwal, Additional Secretary, Ministry of Health and Family Welfare, Government of India emphatically stated that NeHA would be a reality soon and the Central Government is serious about ensuring adoption of the Government-approved EHR standards by healthcare providers.
As such, only a few large hospitals extend their investments to EHR systems due to lack of clinical domain expertise, awareness of standards around EHR and lack of availability of good EHR systems with high usability. However, healthcare IT investment on clinical systems is gaining traction due to the Government regulations on Central Government Health Scheme (CGHS) & Ex-Servicemen Contributory Health Scheme (ECHS) empanelment, wherein the agreement signed with the providers mandates that the hospital has to use a system that complies with the approved HIT & EHR standards within 1 year of the signing of the agreement. This has been in force for agreements signed since 2014-15. Secondly, the need to have the National Accreditation Board for Hospitals & Healthcare Providers (NABH) accreditation to enrol as providers for various government insurance schemes and now also for a few private schemes has assisted in gaining traction.
The hospitals have realised that the only way to go forward is to improve operational efficiency across departments and build smarter systems and processes, and for this hospitals have to invest in IT in their clinical workflows and also in processes. However there are progressive hospitals in the country who have adopted EHR systems that comply with international standards, way before the Government of India published EHR standards, such as the Cloudnine Hospital Chain, the leading player in the country specialising in mother & child care. Cloudnine Hospital Chain, which was our first EHR customer in India, has grown to over 16 sites across the country. It follows the smart hospital format, which many of their competitors today are trying to replicate.
Adoption by clinicians is the key to success of EHR systems. Overall, our research suggests that the main reasons for low adoption are Usability and Accountability. In order to overcome these challenges, we built a highly usable system with features like machine learning and many more, which helped physicians to practice on the system at a faster rate and consult more patients. In the US, we witnessed close to 100 per cent adoption by doctors in the 20 odd hospitals that used our EHR platform by ensuring that all clinicians, such as nurse, pharmacist and over 35 such roles, were equally accountable as the doctors for delivery of care. Even in India we see similar high adoption levels by doctors at over 30 sites.
How can patient awareness improve EHR adoption?
Markets always respond to customers demands and expectations. Every industry would initially resist change even if the benefits are obvious or huge. Regulations and customers demands are facilitators that can help overcome this resistance.
Awareness will ensure patients demand their EHR from care providers. Patients need to be aware that their health records updated and made available to them is as much part of their paid for service as the doctors treatment plan and advice.
Why in your opinion is clinical decision support system (CDSS) imperative for all healthcare providers?
A good EHR system can strongly impact the healthcare sector by reducing the number of clinical errors that occur due to lack of informed clinical decision-making or evidence-based clinical protocols or non-adoption of clinical quality measures or processes, among other issues. The EHR system provides the clinicians access to the patients longitudinal health records to take informed clinical decisions. With the patients EHRs in place, the CDSS can alert the clinician, while ordering medications, of any Drug to Diseases, Drug to Drug, Drug to Allergy, Pregnancy, Lactation Interactions or Contraindication that his medication order could have with patients active conditions or medications. Furthermore, it can help and alert clinicians with dosage adjustments they need to make for paediatric patients, or patients with a hepatic or renal condition.
|Lifetrenz EHR System Key Takeaways|
Fully complies with the international & Indian standards
Improves operational efficiency across departments & builds smarter systems
Has built a system addressing Usability & Accountability factors
Has witnessed 100% adoption by doctors in 20 odd hospitals in the US
Has been witnessing similar high adoption levels over 30 sites in India
Provides access to patients longitudinal health records
Integrates features to reduce the number of clinical errors
Clinical Treatment Protocols and Clinical Care Pathways in the EHR systems can help healthcare providers define these based on evidences and ensure quality of healthcare delivery and ensure that the lack of experience or knowledge of the younger or lessexperienced clinicians do not lead to clinical errors.
Defining Clinical Quality Measures (CQM) and processes in the EHR system, can help with the actual measurement of adoption of CQMs. A good EHR system can help in ensuring adoption at the time of care delivery through alerts/reminder triggers, which is better than just measuring adoption post the event.
EHR systems with Physician Monographs, Drug Information, Hepatic and Renal Monographs and several other such references, all within reach and context-based while consulting, ordering medication or building the patients Care Plan, will immensely assist the physician to take informed clinical decisions.
Whats the future of healthcare IT in India?
The future of healthcare IT innovations in this country depend on how fast can we cross the barriers and lay the foundation required for EHR adoption. Once this is achieved, we as a nation can even move ahead of developed nations on healthcare IT innovations.
At dWise Healthcare, we have taken a decisive step by providing an EHR system free of cost for lifetime to the primary care market in the country. As such, 80 per cent cases of healthcare incidence of patients are addressed by the primary care segment, and longitudinal health records or EHR of patients can become a reality, only when this segment also uses EHR systems.
For our innovative approach to healthcare IT, dWise Healthcare was recently rated by a media house as the Most promising Healthcare Solution Provider in the country for 2016.