EHR – A roadmap for India
An electronic health record (EHR), or electronic medical record (EMR), refers to the systematised collection of patients’ health information electronically-stored in a digital format. The fact that these records can be shared across different health care settings makes it a very efficient tool for improving the quality and effectiveness of healthcare.
Looking at a country like India with its’ billion plus population, limited insurance coverage, high out-of-pocket expenses, EHR will go a long way in making quality healthcare accessible as well as affordable.
Electronic Medical Records implementation experiences vary greatly as one move from country to country and from one EMR system to another. The value and importance of EMRs has been repeatedly demonstrated in Europe and USA. While there are now many successful implementations of EMRs in both hospital settings and ambulatory practices, widespread adoption and dissemination is the exception rather than the rule. Barriers to adoption are sometimes inherent in the design and sometimes related to organizational issues.
In India, the level of use of ICT in the healthcare sector has been lower in comparison to other countries; though some of the corporate hospitals such as Max Health, Apollo, Sankara Nethralaya, Fortis, etc., have implemented integrated ICT systems in place, covering all aspects, i.e., registration and billing as well as laboratory and clinical data. However, even in private hospitals, EMRs are rarely exchanged between hospitals. These remain in the same hospital and are referenced when the patient visits again. There is no authentic report on the number of patients whose EMRs/EHRs have been stored so far.
Dr. Sushil Kumar Srivastava from Ministry of Electronics and Information technology did a study on EHR implementation across the countries and proposed a roadmap for India. He has identified the following as the top focus area for nationwide EHR implementation.
1. ICT infrastructure – Public health facilities have very little ICT infrastructure. Investments have to be made in procurement of hardware and software. It is also suggested to use free and open Source EMRs, and setting up of a secure and reliable communication for information exchange.
2. Policy & Regulations – A national health IT policy need to be formulated to establish standards and ensure interoperability between systems. As EMR involves sensitive data, regulations are needed to ensure privacy protection. Need based exchange of EMR data among health institutions need to be made mandatory and the health data need to be better utilized for clinic trials.
3. Standards of Interoperability – Dr. Srivastava proposes setting up agencies to formulate standards 7 guidelines, monitor adherence and make revisions.
4. Research, Development & Education – Aiming at continuous improvement, he proposes funding of R&D projects, designing specialized courses in Healthcare IT, development on online courseware, sharing of best practices and international collaboration.
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