Electronic medical record systems can help improve the efficiency and delivery of healthcare services in India. The Union and State Governments must make efforts to promote its adoption so as to achieve universal health coverage, writes Mohitkumar Daga
Universal Health Coverage (UHC) has been a long-sought goal for consecutive administrations in India. The quest for a universal safety net for health-related expenditure is important for a country where, as per the 71st round of Survey by the National Sample Survey Organisation, less than 14 per cent of the rural households have access to any form of health insurance and they spend an average amount of Rs16,900 for every case of hospitalisation.
As a prerequisite to deploy an efficient and effective UHC system, it is necessary to create an enabling ecosystem which includes the digitisation of all health records within the healthcare system.
In 2011, the High level Expert Group for UHC for India had suggested the adoption of electronic medical records (EMR) mechanism to enable equitable delivery of health services to the people.
Simply, an EMR or electronic health record (EHR) is a digital summary of various medical records that are generated whenever an individual interacts with any healthcare service. EHRs are designed to be used beyond any one health organisation and to share information with other health care providers, such as laboratories and specialists, so as to contain information from all professionals involved in the patient’s care.
EHR allows better diagnosis and care for the patient as it provides an overview of the patient’s history. As a large proportion of health expenditure is spent on diagnostics/lab tests, EHR can lead to significant savings for the patients as it allows re-use of past results. EHR can help increase accountability of healthcare personnel in cases of medical malpractice.
Finally, in an UHC regime, with the participation of private insurers, a well-functioning EMR system can help insurers design and optimise their products, while providing easy portability for patients between providers, thus increasing the competitiveness of the health insurance market.
On the policy level, the Ministry of Health and Family Welfare notified EMR/EHR standards for India in September 2013. However, these standards have not been made mandatory and State Governments have only been advised to adopt EMR standards in their healthcare systems.
In May 2012, revised rules for Clinical Establishments Act mandated the “maintenance and provision of EMR/EHR for every patient”" for registration and continuation of all clinical establishments. In addition, EHR has been made mandatory for empanelment of hospitals under the Central Government Health Scheme. The Ministry of Health too has released a concept note on the establishment of a National e-Health Authority (NeHA) as a nodal body responsible for the development of an integrated health information system for the country.
In spite of all these provisions, the adoption of EHR has been inconsistent and more is prevalent in private hospitals only. Even in case of hospitals that have adopted EHR, the systems do not always meet the interoperability norms which are necessary for a health system wide integration.
Some serious challenges impede the adoption of system-wide EHR in India, which needs to be addressed immediately. As per National Family Health Survey III, more than 34.8 per cent of the population relies on private non-institutional points of care like single doctor clinics. Smaller clinics do not transition to EHR due to the high initial investment involved.
This, along with the incomplete coverage of Aadhar as a unique and multipurpose identifier for linking EHRs poses significant issues for implementation. The availability of IT infrastructure and Internet connectivity in rural health centres also remains poor, in spite of mandated requirements under the Indian Public Health Standards. Internationally, the reluctance by practitioners in adopting new systems has been known to slow down the transition to EHR systems.
In order to address these issues, a strategic approach to promote the adoption of EHR needs to be adopted by both the Central and State Governments. A large amount of investment (possibly in public–private partnership mode) will be required to deploy EHR systems in public hospitals and set the trend along with the creation of NeHA for regulation of these systems.
Some States like Tamil Nadu have taken initial steps to implement EHR. The Tamil Nadu Health Systems Project has deployed a hospital management information system with EHR in over 1,771 PHCs and 267 secondary care hospitals.
A set of financial and regulatory incentives and disincentives will have to be put in place to encourage small clinics and private practitioners to become a part of the EHR regime.
The Aadhar database needs to be leveraged to link health records across healthcare and insurance providers. The Ministry of Health and Family Welfare must consider creating an enabling legislative framework for the adoption of EHR.
(The writer is research and knowledge support lead at Swaniti Initiative)
