reasons for having a challenges of capturing rich patient histories in computable form, latest global development and standards to enable lifelong electronic health records to be integrated from diverse system, latest India developments and standards to enable lifelong EHR,

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HEALTH INFORMATIC AND TECHNOLOGY OF NURSING
UNIT – 4 (B) & SHARED CARE AND ELECTRONIC HEALTH RECORDS
PREPARED BY DOLISHA WARBI

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CHALLENGES OF CAPTURING RICH PATIENT HISTORIES IN COMPUTABLE FORM:
Capturing rich patient histories in a computable form can be challenging for several reasons,
including;
Complexity
&
variability
of patient
histories
Interoperab
ility
Data quality
and
completeness
Privacy &
security
concerns
Standardiza
tion & data
modeling

3. Cont..
1. Complexity and variability of patient histories:
• Patient history can be complex and varied, including medical, social and
environmental factor that can influence patient health. Capturing relevant data
information required comprehensive approaches.
2. Interoperability issues:
• Storing of data from different system may not be compatible with other system
to communicated and make it difficult to enter or transfer between system.
3. Data quality and completeness:
• Capturing a patient’s health data required accurate and complete data.
• Data quality issue, e.g. Missing, incomplete etc becomes a challenges.
4. Privacy and security concerns:
• Storing data or information raised privacy and security concern.
5. Standardization and data modelling:
• Capturing patient history in a form required a standardized approaches to data
modelling and structuring. Without standardization, data may be inconsistent or
incompatible, making it difficult to share in another systems.
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4. LATEST GLOBAL DEVELOPMENTS & STANDARDS TO ENABLE LIFELONG ELECTRONIC
HEALTH RECORDS TO BE INTEGRATED FROM DIVERSE SYSTEM:
Several global developments and standards aimed at enabling lifelong electronic
health records including;
FHIR (Fast Healthcare Interoperability resources):
• It is a standard for exchanging health information electronically.
• It designed to be flexible, fast, and easy to implement.
• it allow to exchange data between different health IT system.
• It has been widely develop around the world.
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HOSPITALS
PATIENTS
DIAGNOSTIC LABS
PUBLIC HEALTH
AGENCIES
PHARMACEUTICA
L
PARAMEDIC
SERVICES
FHIR HEALTH
EXCHANFGES

5. HL7 (HEALTH LEVEL 7):
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• Is a set of international standard for the exchanges, integrations, sharing and
retrieval of electronic health information.
• HL7 is widely used in health care and is supported by many health systems and
vendors.

6. SMART ( Substitutable Medical Apps, Reusable Technologies):
SMART is a framework that allowed healthcare provider to build an integrated
medical apps into their EHR system.
The SMART framework provides a standard way for apps to access patient data
securely and easily.
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7. Open EHR:
• It is an open standard for the storage, retrieval and extent of electronic health
records.
• It provides a common data model and language for healthcare data, allowing for
better interoperability between desperate system.
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8. IHE (Integrating the Healthcare Enterprise):
• IHE is an initiative aimed at improving the interoperability of health care IT
system.
• It provides a framework for the exchange of health information between
different system and promote adoption of standard such are FHIR and HL7.
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9. EHR4CR (Electronic Health Records for Clinical Research):
• EHR4CR is a European Union aim at improving the use of electronic health
record in clinical research.
• It provide standardized approaches for assessing and using patient data for
research purposes, helping to bridge the gap between clinical practice and
research.
EHR4CR
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Infrastructure
(end – user)
Tools
semantics
Hospital
Connectors

10. LATEST INDIA DEVELOPMENTS AND STANDARDS TO ENABLE LIFELONG EHR:
• This developments. And standard are expected to play a crucial role in enabling
lifelong electronic health record to be integrated for disparate system in India
• They are expected to improve the efficiency and quality of healthcare delivery,
reduce costs and improve passion outcome.
• some of the lattice development involved
a) National Digital Health Mission (NDHM):
The NDHM was launched in August. 2020 by the government of India.
• It’s aim was creating a national digital health ecosystem that allow for the
seamless exchange of health data across different system.
• It also aim to provide every Indian citizen with a unique help ID, which can be
used to assess their EHRs anywhere in the country.
KEY FEATURES OF NDHM INCLUDED:
• Digital health ID.
• Personal health records.
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11. Cont..
• Health facility registry
• Telemediacation.
• Health information exchanges.
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12. B) HEALTH INFORMATION EXCHANGE (HIE):
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Health information exchange is the electronic sharing of healthcare information
between different healthcare providers and organization, such as hospital, clinic,
labs, and pharmacies.
HIE enable to secure exchange of patient health information, including medical
histories, test results or any medication list, and other important health data.
• Its goals is to improve the quality and efficiency of health care delivery by
providing timely and accurately health information to health care provider at the
point of care.
• It reduce medical error, improve patient safety and facilitate better care
coordination between different providers.
• Enabling population help management and outbreak management.
• Facilitating research and data analysis for clinical and public health purposes.

13. C) NATIONAL HEALTH STACK (NHS):
The NHS provides standardized approach to data exchange and interoperability,
enabling different system to integrate with each order seamlessly.
NHS is a framework proposes by Govt of India to create a digital health
infrastructure for the country.
Its aim is to create a unified health ecosystem that connected with stakeholder in
the health care system, such as patient, health care providers, insurance provider
and the government. The NHS is built on a set of foundational building block,
which include;
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HEALTH
ID
NHS
HEALTH
RECORDS
HEALTH
ANALYTICS
REGISTERY
SERVICES
HEALTH
INFORMATION
EXCHANGES

14. Cont..
HEALTH ID:
The health ID is a unique identifier assigned to each individual that contain their
personal health information.
HEALTH RECORDS:
The health record modeling enables the creation, storage and sharing of electronic
health records.
REGISTERY SERVICES:
Registry services provide essential database of healthcare provider, insurance,
provider and other stakeholder in the healthcare system.
HEALTH ANALYTICS:
Health analytic enabled analysis of health data to identify trend, patterns and
insight that can be used to improve healthcare delivery.
HEALTH INFORMATION EXCHANGES:
Health information exchange enabled the secure exchange of health information
between different healthcare provider and organization.
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15. d) INDIAN EHR STANDARD:
• The standards is bases on internationals standards such as HL7 and FHIR are
provide guidelines for data collection, storage and exchange.
• The purposes of creating a digital health manufacturer that can support and
exchange of health information between the different stakeholder in the health
care system.
• The standard has been developed by the Ministry of Health and Family Welfare
in collaborations with the various order stakeholder in the health care sector.
• Some of the key of EHR standards develops in India include;
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HEALTH INFORMATION EXCHANGE STANDARD
DATA ELEMENTS AND INTEROPERABILITY
STANDARD
CLINICAL TERMINOLOGY STANDARD
EHR IMPLEMENTATION GUIDELINES
EHR ARCHITECTURE STANDARD

16. Cont..
HEALTH INFORMATION EXCHANGES STANDARD:
These standards specified technical requirements for the secure exchange of health
information between the different healthcare providers and organization, which includes
exchange protocol, security and privacy.
DATA ELEMENTS AND INTEROPERABILITY STANDARD:
This standard specify the data elements that should be included in EHR as well as the
interoperability standard that should be used to ensure the different EHR system can
exchange data with each other.
CLINICAL TERMINOLOGY STANDARDS:
This standard specified a clinical terminology that should be used in an EHR to ensure
consistency and accuracy of health data across different provider and organization.
EHR ARCHITECTURE STANDARD:
This standard specified overall architecture of EHR system included the data storage and
retrieval mechanism as well as the user interface and user experience design.
EHR IMPLEMENTATION GUIDELINES:
This guideline provide a framework for implementing EHR system in the healthcare
organization, including best practice for a data migration, user training and system
maintenance.
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17. e) FAST HEALTHCARE INTEROPERABILITY RESOURCES (FHIR) INDIA:
FHIR India is a group of healthcare professionals, academics and technology
expert who are working to promote adoption of FHIR in India.
The group provide trading and support to healthcare provider and vendors and
work to develop FHIR based application and solution that can improve the patient
care.
FHIR INDIA HAS SEVERAL OBJECTIVES, INCLUDING:
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DEVELOPING FHIR BASED
APPLICATION AND SOLUTION
PROVIDING TRAINING AND SUPPORT
PROMOTING THE ADOPTION OF FHIR
IN INDIA
FACILITING COLLABORATION

18. Cont..
PROMOTING THE ADOPTION OF FHIR IN INDIA:
FHIR India aims to rise awareness about the benefit of FHIR and encourage its
adoptions by health care provider and technology vendor in India.
DEVELOPING FHIR- BASED APPLICATIONS AND SOLUTION:
FHIR India member work on developing FHIR basis applications and solutions that
can improve patient care and healthcare outcome in India.
PROVIDING TRAINOING AND SUPPORT:
FHIR India provides training and support to health care provider and technology
vendors who are interested in adopting the FHIR.
FACILITATING COLLABORATION:
FHIR India facilitate collaboration between different stakeholder in the healthcare
ecosystem, including healthcare provider technology vendor policymakers and
patient.
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