Standardising the healthcare information technologies along with regulatory reforms needs to be the primary drivers of increased EHR adoption in India, writes Prof Supten Sarbadhikari, Dean, International Institute of Health Management Research, Delhi for Elets News Network (ENN).
Digital health is all about electronically connecting the points of care so that health information can be shared securely. This is the first step to understand how digital health can help deliver safer and better quality healthcare. Digital health includes mobile health, health information technology, wearable devices, telehealth and telemedicine and personalised medicine.
The cornerstone of digital health is EHR or Electronic Health Record, a digital version of a patients medical record. EHRs are real-time, patient-centered records that make information available instantly and securely to authorised users.
While an EHR does contain the medical and treatment histories of a patient, an EHR system goes beyond standard clinical data collected in a providers office and can be inclusive of a broader view of a patients care. EHRs can:
- Contain a patients medical history, diagnoses, medications, treatment plans, immunisation dates, allergies, radiology images, and laboratory and test results
- Allow access to evidence-based tools that providers can use to make decisions about a patients care
- Automate and streamline provider workflow
Automatic integration of EHR systems and intravenous medication infusion devices equipped with dose error reduction software (drug libraries), is termed intravenous (IV) interoperability. This should serve as the goal towards which all healthcare systems work to maximise patient safety.
Standardising the healthcare information technologies along with regulatory reforms needs to be the primary drivers of increased EHR adoption in India.
To realise the full benefits that EHR solutions can deliver, medical organisations must carefully plan their EHR implementation to achieve optimum utilisation. Only then these organisations will achieve the improvements they desire, and ultimately realise a positive return on their technology investments.
The Ministry of Health and Family Welfare has already notified the standards to be used for exchange of health information. The second edition of the standards was notified in December 2016. Further, an Integrated Health Information Platform (IHIP) is being set up for exchange of health information in an interoperable manner.
National Health Policy-2017
The National Health Policy-2017 advocates extensive deployment of digital tools for improving the efficiency and outcome of the healthcare system. The policy aims at an integrated health information platform or system to serve the needs of all stakeholders and improve efficiency, transparency, and citizens experience.
Delivery of better health outcomes in terms of access, quality, affordability, lowering of disease burden and efficient monitoring of health entitlements to citizens, is the goal. The policy underscores the need for establishing federated national health information architecture, to roll-out and link systems across public and private health providers at State and national levels consistent with Metadata and Data Standards (MDDS) and Electronic Health Record (EHR) Standards.
Creation of registries (i.e. patients, provider, service, diseases, document and event) for enhanced public health/big data analytics, creation of health information exchange platform and national health information network, use of National Optical Fiber Network (NOFN), use of smart phones/tablets for capturing real time data, are key strategies of the National Health Information Architecture.
The National Health Policy-2017 advocates scaling of various initiatives in the area of tele-consultation which will entail linking tertiary care institutions (medical colleges) to district and sub-district hospitals which provide secondary care facilities, for the purpose of specialist consultations.
Implementing an EHR is not a straight-forward process, and a one-size-fits-all approach is ineffective, since numerous variables exist in every practice. An optimised implementation will make the difference between an EHR that drives improvements in efficiency and care delivery, versus an EHR that is abandoned or even replaced.
The best practices for EHR implementation usually involve the following areas:
- Securing physician leadership
- Setting realistic expectations
- Adequate and appropriate documentation
- Acceptance of evolving staff roles and responsibilities
Cost components to consider when budgeting for an EHR include:
- Software licensing (outright purchase, leasing and/or monthly subscription fees)
- Hardware expenses, depending on the age or capabilities of current equipment
- Configuration and customisation
- Support and maintenance
- Potential lost productivity that impacts revenue during implementation, training and initial use of system
For an EHR to be successful it must maximise clinician efficiency. An emphasis on performance (availability and speed) will have to be in place to make EHRs successful. It must be remembered that EHRs are not stand-alone systems but are systems of systems.
While the long-term benefits of EHRs are being uated, patient portals are a beacon of encouragement. As a single component of or complement to an EHR that helps achieve better care, better health, and reduced costs, the patient portal can drive significant value.
Optimally deployed with self-service identity management tools, health systems can magnify the importance of their patient portals to enhance patient loyalty, increase enrollment and utilisation of targeted patient groups, and increase the quantifiable clinical and financial benefits for patients and providers alike.
HIM: The Way Forward
Health Information Management (HIM) professionals are well trained in the latest information management technology applications and understand the workflow in any health care provider organisation.
Health Information Managers are vital to the daily operations management of health information and EHRs. They ensure that Data Quality is maintained, by applying the principles of change management and continuous capacity building through education and training. They ensure that the health information and records of a patient are complete, accurate, protected and meet the desired and stipulated medical, legal and ethical standards.
Therefore, it must be made mandatory to appoint an adequate number of health information managers, according to the size of the healthcare organisation, to ensure safe and smooth adoption of digital health in India, leading to informed and safer healthcare delivery.
(The writer is Dean, International Institute of Health Management Research, Delhi)