April 2007

Advocacy for a Common EHCR Architecture

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Developing a common low cost electronic healthcare records (EHCR) system in India involves great challenge. There is a need to evolve a centralized system of storing, accessing and processing the medical records in electronic form, with all applicable standards and security support. The existing, so called EMRs are proprietary, with no interoperability, and are very costly. They mainly cater to the need of big hospitals in India.

The healthcare industry in India is undergoing significant growth. Quality healthcare is available in the country, at a much more affordable rate than in the west, which has resulted in a boom of sorts in medical tourism. However, at the same time there is a need to strengthen the public health services so as to make quality healthcare reach the socially and economically challenged population of the country.The primary health care (PHC) centers have to be empowered to reduce the load on secondary and referral healthcare centers. Presently there is a heavy load of patients on secondary and specialty healthcare centers due to non-efficient system of primary healthcare (PHC) centers. The power of information and communication technology can change the face of healthcare scenario in India, if the government takes up it as a mission mode project.

National Health Policy-2002 (NHP) envisages an IEC policy,which maximizes the dissemination of information to those population groups, which cannot be effectively approached through only the mass media. However, the National Health Policy has not emphasized on taking technological advantage in the health sector, especially in public healthcare. The time is ripe to set the ball rolling and an effective answer to address the healthcare needs of India through the aid of ICT, lies in electronic healthcare record.

Keeping medical record electronically at one place and accessing it electronically by healthcare centers may change the present way of health services in India. The role of electronic healthcare record (EHCR) is of great significance in terms of overall effectiveness of healthcare services in this country. If entire medical history of the patient is available at one place (even if consultation has been given in different hospitals),there will be less time required to provide medical assistance to the patient. Besides here are number of situations where patient is not able to collect the record and all tests, history,etc. has to be done again and again over a period of time. The EHCR will be saving hard earned money of patients if the lab tests are readily available for examination.

In this regard, Indian health sector should take a leaf from the Indian stock and share market, where entire scripts are kept electronically in DEMAT form by the users in the stock exchange and trading worth of millions of rupees is done online,on a daily basis. A similar system has to be developed for health records that may be unique in the Indian health sector.

However to develop a common low cost electronic healthcare records (EHCR) system in India involves great challenge. There is a need to evolve a centralized system of storing, accessing and processing the medical records in electronic form, with all applicable standards and security support. The existing, so called EMRs are proprietary, with no interoperability, and are very costly. They mainly cater to the need of big hospitals in India.

The EHCR should be used right from the primary healthcare centers to private nursing homes. Like PAN card, a healthcare card should be issued to all, containing unique MRI (medical record Id) on it. To encourage the use of card, the card holders may be given additional benefits like priority in medical checkup, cost benefit in pathological testing, etc. Development of a common, low cost EHCR has potential opportunities of private-public partnership (PPP) in its implementation. Health insurance companies, pharmaceutical companies, medical equipment manufacturers, etc. can be involved in its implementation process, provided their involvement is ensured right from the planning stage of EHCR, in the Indian environment.

Here we attempt to explore the possibilities of developing a low cost, common EHCR for India, consisting of all applicable international standards in Indian conditions. First of all let us examine what EHCR actually is and also the progression of EHCR from automated medical records.

The progression does comprise of the following levels:

1.The automated medical record is a paper-based record with some computer generated documents.

2.The computerized medical record (CMR) makes the document of level 1 electronically available.

3.The electronic medical record (EMR) restructures and optimizes the documents of the previous levels, ensuring interoperability of all documentation system.

4.The electronic patient record (EPR) is a patient-centric record with information from multiple institutions.

5.The electronic health record (EHR) adds general healthrelated information to the EPR that is not necessarily related to the diseases.

The electronic health record shall broadly facilitate:

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