Electronic Health Record Standards For India

From the perspective of Indian Healthcare system, patients visit several health providers, throughout their life span, right from visiting a sub-center, community-center or primary-health centre in rural setups, or a general practitioner in his local vicinity, to a government /private hospital or clinic at the district, city, state or central level. Health records get generated with every clinical encounter during these ambulatory, inpatient or emergency visits. However, most health records are either lost, or remain in the custody of health care providers and eventually get destroyed, as per the retention period of medical records generally followed by hospitals in the country i.e. for 5 years for out-patient records, and 10 years for in patient records. Medico legal records are however retained permanently. This is applicable to health care setups with a proper medical record department only. 

There may be negligible to no health records maintained by private practitioners, at clinic setups and by rural healthcare setups. A typical Indian patient with varying literacy and awareness level usually does not retain his clinical documents either. Medical record is the property of the hospital and ‘not’ of the patient, clinical department or care provider/s. The patient also has no proprietary right on his own clinical record today. What the patient carries with him is the discharge summary of his clinical encounter along with his investigation reports and usually radiology films/images. Also, important clinical data is not available for research and for reference to aide in clinical decision support. Study of disease trends and statistical analysis of clinical nature also suffers.



Due to these and many more reasons, having an EHR of a patient with health records of each clinical encounter at varying healthcare setups, be it government or privately owned, is ‘actually’ a dream come true for India. In the coming years, EHR of an Indian patient may even be accessible by care providers of other countries and vice versa, especially with the boom in global medical tourism trends.

As per the EHR standards released in August 2013 by the Ministry of Health & Family Welfare, Government of India, ‘for creation of a true electronic health record of an individual it is imperative that all clinical records created by the various care providers that a person visits during his/her lifetime be stored in a central clinical data repository or at least be shareable through the use of interoperable standards. Adequate safeguards to ensure data privacy and security must strictly be adhered to at all times. Patients must have the privilege to verify the accuracy of their health data and gain access whenever they wish to do so’.2The EHR standards of India emphasize on ‘Patient’ as the authorized owner of his health data’. The standards aim to develop a system which would allow one to create, store, transmit or receive electronically, the ‘Electronic Protected Health Information (ePHI)’of a patient, using reliable media for data storage and transfer. EHRs can bring a patient’s complete health information together for supporting better clinical decisions, and more coordinated care amongst various care providers.

These standards emphasize the use of National UID or AADHAR number as the primary or secondary Unique Health Identifier (UHID) of a patient visiting a healthcare facility. The AADHAR number will serve as the unique patient identifier for all healthcare organizations across the nation. The other ID, may be used to identify the patient within the organization and as a reference in its EMR system. The EHR standards also define the Healthcare IT (HCIT) Standards applicable for India, besides the inclusion of National UID or AADHAR number. So, going forward, the AADHAR number will act as the unique identifier for the EHR of an Indian citizen, which will be a longitudinal health record of a citizen’s lifespan with several clinical encounters in different care settings.



Software companies who are looking at implementing their Healthcare Information Systems (HIS), EMR or EHR applications in India are working towards compliance with the EHR standards of India. Healthcare providers and organizations also, now, have a framework with guidelines, for effective implementation of these systems in their healthcare settings, right from choosing the right IT Infrastructure to selection of a modern HIS/EMR/EHR application with a futuristic design towards integrated healthcare for India. The basic idea of the EHR standards is to have a country wide rollout of EHR for all healthcare organizations and link it to the National UID of the patient (AADHAR). An article in Forbes India magazine stated that ‘with UID database residing in the cloud, even a rudimentary EHR linked to it and stored in the cloud along with critical information, say, about blood group, allergies, chronic illness, long term medication, etc. can go a long way not only in better healthcare delivery but even for gathering epidemiological data. Connecting rural and urban healthcare delivery systems through UID and EHR standards seems like a magnanimous task for now, but if given aggressive timelines and adequate impetus of implementation, will surely see the foreseen success.

For complete details of EHR Standards for India, please check following link:
http://mohfw.nic.in/showfile.php?lid=1672

Difference between EMR, EHR & PHR

Electronic Medical Records

Electronic medical records (EMRs) are digital versions of the paper charts in clinician offices, clinics, and hospitals. EMRs contain notes and information collected by and for the clinicians in that office, clinic, or hospital and are mostly used by providers for diagnosis and treatment. EMRs are more valuable than paper records because they enable providers to track data over time, identify patients for preventive visits and screenings, monitor patients, and improve health care quality.

Electronic Health Records

Electronic health records (EHRs) are built to go beyond standard clinical data collected in a provider’s office and are inclusive of a broader view of a patient’s care. EHRs contain information from all the clinicians involved in a patient’s care and all authorized clinicians involved in a patient’s care can access the information to provide care to that patient. EHRs also share information with other health care providers, such as laboratories and specialists. EHRs follow patients – to the specialist, the hospital, the nursing home, or even across the country.

Personal Health Records

Personal health records (PHRs) contain the same types of information as EHRs—diagnoses, medications, immunizations, family medical histories, and provider contact information—but are designed to be set up, accessed, and managed by patients. Patients can use PHRs to maintain and manage their health information in a private, secure, and confidential environment. PHRs can include information from a variety of sources including clinicians, home monitoring devices, and patients themselves.

Electronic Health Records in NutShell

The Basics

An electronic health record (EHR) is a digital version of a patient’s paper chart. EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users. While an EHR does contain the medical and treatment histories of patients, an EHR system is built to go beyond standard clinical data collected in a provider’s office and can be inclusive of a broader view of a patient’s care. 

EHRs can:

• Contain a patient’s medical history, diagnoses, medications, treatment plans, immunization dates, allergies, radiology images, and laboratory and test results
• Allow access to evidence-based tools that providers can use to make decisions about a patient’s care
• Automate and streamline provider workflow

One of the key features of an EHR is that health information can be created and managed by authorized providers in a digital format capable of being shared with other providers across more than one health care organization. EHRs are built to share information with other health care providers and organizations – such as laboratories, specialists, medical imaging facilities, pharmacies, emergency facilities, and school and workplace clinics – so they contain information from all clinicians involved in a patient’s care.

Benefits of Electronic Health Records

Our world has been radically transformed by digital technology – smart phones, tablets, and web-enabled devices have transformed our daily lives and the way we communicate. Medicine is an information-rich enterprise. A greater and more seamless flow of information within a digital health care infrastructure, created by electronic health records (EHRs), encompasses and leverages digital progress and can transform the way care is delivered and compensated. With EHRs, information is available whenever and wherever it is needed.1

The Health Information Technology for Economic and Clinical Health (HITECH) Act, a component of the American Recovery and Reinvestment Act of 2009, represents the Nation’s first substantial commitment of Federal resources to support the widespread adoption of EHRs. As of August 2012, 54 percent of the Medicare- and Medicaid-eligible professionals had registered for the meaningful use incentive program.1

When fully functional and exchangeable, the benefits of EHRs offer far more than a paper record can. 

EHRs:

• Improve quality and convenience of patient care
• Increase patient participation in their care
• Improve accuracy of diagnoses and health outcomes
• Improve care coordination
• Increase practice efficiency and cost savings

Transformed Health Care

Electronic Health Records (EHRs) are the first step to transformed health care. 

The benefits of electronic health records include:

• Better health care by improving all aspects of patient care, including safety, effectiveness, patient-centeredness, communication, education, timeliness, efficiency, and equity.
• Better health by encouraging healthier lifestyles in the entire population, including increased physical activity, better nutrition, avoidance of behavioral risks, and wider use of preventative care.
• Improved efficiency and lower health care costs by promoting preventative medicine and improved coordination of health care services, as well as by reducing waste and redundant tests.
• Better clinical decision making by integrating patient information from multiple sources.

Advantages of Electronic Health Records

EHRs and the ability to exchange health information electronically can help you provide higher quality and safer care for patients while creating tangible enhancements for your organization. EHRs help providers better manage care for patients and provide better health care by:

• Providing accurate, up-to-date, and complete information about patients at the point of care
• Enabling quick access to patient records for more coordinated, efficient care
• Securely sharing electronic information with patients and other clinicians
• Helping providers more effectively diagnose patients, reduce medical errors, and provide safer care
• Improving patient and provider interaction and communication, as well as health care convenience
• Enabling safer, more reliable prescribing
• Helping promote legible, complete documentation and accurate, streamlined coding and billing
• Enhancing privacy and security of patient data
• Helping providers improve productivity and work-life balance
• Enabling providers to improve efficiency and meet their business goals
• Reducing costs through decreased paperwork, improved safety, reduced duplication of testing, and improved health.

Meaningful Use

One of the best ways to ensure you take full advantage of the benefits of electronic health records is to achieve meaningful use. By achieving meaningful use, you can reap benefits beyond financial incentives.

Technical features

• Digital formatting enables information to be used and shared over secure networks
• Track care (e.g. prescriptions) and outcomes (e.g. blood pressure)
• Trigger warnings and reminders
• Send and receive orders, reports, and results

Health Information Exchange

• Technical and social framework that enables information to move electronically between organizations
• Reporting to public health
• ePrescribing
• Sharing laboratory results with providers

Standards

• ANSI X12 (EDI) - transaction protocols used for transmitting patient data. Popular in the United States for transmission of billing data.
• CEN's TC/251 provides EHR standards in Europe including:
• EN 13606, communication standards for EHR information
• CONTSYS (EN 13940), supports continuity of care record standardization.
• HISA (EN 12967), a services standard for inter-system communication in a clinical information environment.
• Continuity of Care Record - ASTM International Continuity of Care Record standard
• DICOM - an international communications protocol standard for representing and transmitting radiology (and other) image-based data, sponsored by NEMA (National Electrical Manufacturers Association)
• HL7 - a standardized messaging and text communications protocol between hospital and physician record systems, and between practice management systems
• ISO - ISO TC 215 provides international technical specifications for EHRs. ISO 18308 describes EHR architectures
• xDT - a family of data exchange formats for medical purposes that is used in the German public health system.