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eHealth Conference 2012 Gaur Sunder
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eHealth Conference 2012 Gaur Sunder


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  • 1. Developing eHealth Strategies toDeliver an Effective EHR System India Case Study Gaur Sunder Medical Informatics Group C-DAC, India
  • 2. Agenda• Introduction & Background• Issues & Challenges• Strategies
  • 4. Indian Healthcare Scenario• Tiered Rural and Urban Healthcare System• Doctor Patient ratio at 1:2000 (average)• Robust network of private healthcare providers and ancillary services• Private sector share a large load and service profile (about 50%~70%)• Majority of medical graduates are provided by public system (about 80%)
  • 5. EHR/EMR Systems in India• Scant but few at District level and above have some HIS/HIMS or system• Most public/private large setups have functional HIS/HIMS, some of them have internal EMR/EHR capability• There is no mandated functional interoperable EMR/EHR at any level• There are several Telemedicine setups but mostly without EMR/EHR constructs
  • 6. Building National EMR System• Union Ministry of Health has started consultation for building National EHR System• Few steps already taken: – National EHR Standards Committee by MoH&FW – Technology Prototype for scalable, reliable healthcare repository by MoC&IT – National Knowledge Commission project iHIND
  • 8. EHR Data Sources• Application Communication Protocol• Device Communication Protocol• Database Schemas• Structured Data Transmission• XML Mapping Schemas• Medical Informatics Standards
  • 9. Medical Standards: Current Scenario• EHR Standards – EHR Content Standards – Content Exchange Standards – Codes, Terminologies, Vocabularies• “Proprietary” Data Representation – Local Data Formats – Local Clinical Data Standards – Local Codes, Terminologies
  • 10. Problem of Plenty• No single comprehensive Standard, Terminology, Coding System• Content-based selection of Standards• But Standards change too! – Dependency on evolution, changes in Standards – Localization of existing Standards, Terminologies, Codes – Change in version also costs to implement/adopt
  • 11. Regulatory Environment• No regulation towards enforcing selected eHealth Standards• Comprehensive mechanism for regulation of healthcare, etc. but none for eHealth• Work on since 2003 by IT Ministry and Health Ministry to find an acceptable set of standards• ICT penetration, where available, in Healthcare is focused on operations and not clinical information• Unfortunately, most of HIS/HIMS in use are not designed to maintain clinical data, most don’t follow any established eHealth standards
  • 12. Identification & Duplication• India has begun to allot Unique National Identification Number – Aadhar, to citizens• There are plethora of IDs given by Government Agencies at Rural, District, State, National, and Service levels• All Healthcare system have their own ID assignment policy• Due to illiteracy and time-constraints during data-entry, the demographic records captured are unreliable or duplicated
  • 14. Identification & Duplication• Where UID available, system should readily use it• Where not, then you have plethora of IDs but – IDs are by nature unique – Degree of Uniqueness varies on Zone of system implementation• Maintain a ID Relationships to match records• Search and Identify possible duplication, and: – Preferably, prevent duplication – Or allow merging of records by records keeper
  • 15. Learn from National EHR Programs Country National EHR ProgramAustralia HealthConnectAustria ELGACanada EHRS BlueprintDenmark MedComEngland SpineHong Kong eHR InfrastructureIndia *Recommendation Stage*Netherlands AORTASingapore NEHRSweden National Patient Summary (NPO)Taiwan Health Information Network (HIN)United States of America EHR Meaningful Use
  • 16. Need of the Hour• Building today’s Model openEHR DICOM CCR HL7 CCD of EHR *• Multiple Data Source integration• Many Standards, Multiple data formats, Single Solution? EHR
  • 17. Addressing ProblemsConcerns Solution ApproachMultiple patient identities Maintain ID RelationshipsIncomplete EMR/EHR Cover complete EHR phases/artefactsGeographical spread Design for single/distributed/cloud environmentSolution Scalability Highly scalable architectureMultiple Standards Multi-standard supportFail-safety/Redundancy Distributed/Clustered designPerformance Efficient operationsDesign and Integration Flexibility API for integration with healthcare applicationsSecurity Integrate Security FrameworkLarge Data-set Efficient storage managementVendor Lock-in Build on Open systems
  • 18. DHS: Overall System Architecture
  • 19. Offering• Highly redundant, fail-safe, secure system framework• Works as EHR integrator from various sources• Requires little or no change in your current systems: – Only add as additional underlying layer – If schema is shared then non-standard system could be supported – Requires NO change in workflow, database, application logic – If not supporting certificates, then stop-gap arrangement is possible – Will require marginal change in User management part – Users are obvious to addition – However, tighter integrations are possible using EHR-API• Can be used for Interoperability, Telemedicine, Referrals, Emergency• Any number of consumer application can be built on top• Can be extended further to meet specific requirements• OLAP services can be build on top
  • 20. Challenges• Integration of existing health data in proprietary format into the Distributed Store• Evaluating the Distributed Healthcare Information store in diverse conditions• Absence of Unique Patient/Citizen Database• Willingness of Medical organization / individuals in participating• Adoption by
  • 21. Proposal: Get it working• Work towards promoting eHealth standards• Increase ICT penetration: – Government Programs, Incentives, Regulations – Support with affordable technologies – Utilize available affordable hardware• Bring in regulatory/control body for managing National Health Repository (NHR)• Incentivize interoperability and connecting to NHR• Promote interoperability between Private-Private, Private-Public referral system• Demonstrate in public healthcare system and invite all to join; start with Hospitals, migrate to ancillary providers
  • 22. Thank