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E.H.R Standards for India : GOI Report

Electronic health records are a summary of the various electronic medical records that get generated during any clinical encounter. Without standards, a lifelong summary is not possible as different records from different sources spread across ~80+ years will potentially need to be brought into one summary. To achieve this, a set of pre-defined standards for information exchange that includes images, clinical codes and a minimum data set is imperative.

Foreword to ‘ E.H.R Standards for India ’ by the GOI.

The Government of India, as it goes for the unveiling of National Health Portal, comes out with a definitive guidelines for E.H.R standards in India. The document takes a look at E.H.R standards to be followed throughout different medical provider institutions in India, so that medical data becomes portable and easily transferable. Its amazing to see how many ehealth companies have been stumped because of lack of such a document earlier. This might be good news for a number of companies which foolishly wait for standards to be finalized, instead of simply building the most Flexible, Secure, Doctor & Patient-friendly E.H.R they can.

More importantly , It takes a look at Data ownership.

It says “The health data is owned by the patient while the actual records are owned by the care providers who act as the custodians of the data. 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.

Thankfully, Patients have earned their spot in our policy making. We know that products which do not have the patient interactions in mind will just not succeed. Now that we have a roadmap ahead, It’s a race to the finish for the nascent ehealth industry in our country.

You can download a copy of the document here.

The Inside Story of National Health Portal of India

National Health Portal of India has been on our minds for a long time. This is the inside story of working for the national health portal of India which is scheduled for launch on 1st October 2013, almost four years after it first came under consideration. It’s a very optimistic project and a wordle created from the project report showcases that very well.

First, some history and background.

Backed by the National Knowledge Commission, a working group committee sent its Project Report on setting and developing the national health portal for India in August 2010. The NKC proposed to launch the National Health Information Portal which would serve as a comprehensive source on health information in India. The portal plans to serve as a single point of access for consolidated health information, application and resources on the sector and aim to cater to a wide spectrum of users from citizens, to students, healthcare professionals and researchers.

The proposal also aims to create space for other portals, publishers, IT and non IT based interventions. It is envisaged that private enterprises would join the government in creating new tools and services with the help of all the Data to be collected via NHP. This is a humungous task by any standards and the progress on the portal has been understandably slow.

A recent meet at AIIMS organized by HIMSS India and attended by Dr. Suptendra Nath Sarbadhikari, Project Director, Centre for Health Informatics of the National Health Portal cleared the mystery surrounding the progress of National Health Portal. During the meet, a lot of time was spent on stressing the need for Uniform Data Standards to be adopted so that all EHRs across the country (private and public hospitals) can be connected to the national health portal. With the addition of Prof. Indrajit Bhattacharya, the team at the National Health Portal is now well positioned to take this project forward.

The meet highlighted 3 main topics of discussion;

1) Data standards and Interoperability

2) Mobile apps for content distribution

3) Social Media Help desk and social networking activities

In order to accumulate data from various state health departments, government hospitals and private hospitals, we need a common system for entering the health data. The GOI has not yet taken the effort to set up a recommended set of data standards which can be followed by all hospitals and institutes while storing data. Unless data standards to be followed are finalized soon, linking/ merging of diverse sets of healthcare data will be close to impossible in the future.

Mobile apps and device agnostic websites were identified as an important next step in the project. The project objective is also to improve health literacy of the masses in India. One immediate hurdle for the National Health Portal is the need for authentic and high quality content in multiple languages.  At this stage, It is not desirable that NHP spends its efforts and money creating original content for education of consumers and healthcare practitioners.Except for a core team (4 or 5) of graphic artists and subject matter experts to create interactive and visual media on a daily/weekly basis, the task of content creation could very well be outsourced. The NHP team can always validate the content after creation and before it is uploaded to the website. Besides, a lot of content is freely available from international sources like Centre For Disease Control (CDC) and World Health Organization which can be hot-linked on the portal. Professional content curation and dissemination via mobile apps will play a huge role in providing content for the National Health Portal.

Another important consideration at the NHP meet was the creation of a Social Media Helpdesk for the portal. Social Networking is the new fact of our connected lives today and the NHP plans to make full use of existing platforms like Facebook and Twitter to further its agenda. Social Networking would also be utilized via various health Forums planned on the portal. Social Media will be a key component of the content distribution strategy.

The National Health Portal will always be a work in motion. You, too, can have a say in how that happens. We have created a Facebook page for this project. You can join us on Facebook to share your views/suggestions as well as Tweet us your suggestions by using the hashtag #nhportal.  We will make sure all tweets and comments are forwarded to the right authorities.

This update has also been shared on India Health Network website.

Wearable Technology in Healthcare: Will It Take Root in India?

After self-quantifying apps, with the advent of Google Glasses, Wearable tech is soon going to be a big thing in healthcare.

The movement for self-quantifying patients is not too old. Many experts believe that self-quantifying patients are the logical next step  in evolution of person-centered healthcare. Physicians have found wearable self-quantifying by patients especially useful in management of chronic diseases like obesity, diabetes, heart disease, blood diseases, arthritis etc. With 7 of 10 patients seen in the US by physicians already quantifying themselves using apps and wearable tech, the wearable tech in healthcare market is only destined to grow bigger, at-least in the Indian metros initially. Indian cosmopolitans are just the types to take to this trend sooner (3 to 5 years) rather than later. The unmet demand of self-quantification market in India is presently catered to by a few start-ups like Diabeto (a mobile device),  and we are ready to see more such initiatives soon.

Take a look at some of the affordable wearable tech already present in the markets ranging from bionic lenses to display information, pedometers in shoes, watches as oxymeters, trauma resistant inner-wear and bras with sensors to monitor your heart.

Source: mashable.com via Paul on Pinterest

Indian Healthcare Industry in the 21st Century

 

 You better start swimmin' Or you'll sink like a stone,

For the times they are a-changin'

- Bob Dylan

Healthcare has been changing in drifts and shifts over the past few centuries and Nothing will ever be the same again.

Tim Berners-Lee (father of Internet) made the biggest financial sacrifice in recent times when he refused to patent his hyper text transfer protocol and instead threw it open for the Aam Aadmi. The times of the mai-baap Doctor are numbered. The patient has taken his rightful place as the center of the new healthcare ecosystem, with all other stakeholders working to woo that customer. The recent regulations regarding generic medications will only strengthen this position. Since patient, and not the doctor, will now make the purchasing decision, all stakeholders in this ecosystem (Pharma, labs, hospitals) need to reconsider their strategies and focus on the true consumer.

Many savvy Indian entrepreneurs have already smelt the coffee. Now, many stages of healthcare services can be accessed online. You can track your health using Smartphone apps and websites. When unwell, you can check your symptoms to arrive at a presumptive diagnosis online. It’s easy to search for a suitable physician in your geographical area who you might want to consult. Compare rates and services at various hospitals. Book your appointments. Receive your lab reports and prescriptions in the comfort of home. Join social support groups and get information about alternate treatments or therapies. Store all your health records digitally and get second opinions from anywhere in the world. Doctors can monitor their patients remotely and even tweak treatments from a distance. They can discuss treatments and obtain referrals in secure online platforms. The effect of Internet and social media is just too huge to be ignored.

To borrow an analogy from Jed Weissberg, MD, Senior Vice at Kaiser Permanente, the Choluteca Bridge is a metaphor for today's healthcare ecosystem. The Choluteca Bridge was built by the U.S. Army Corps of Engineers in 1930 with design strength to withstand the worst of hurricanes that affected the area. When Hurricane Mitch came in 1998, it destroyed 150 Honduran bridges, but not the Choluteca Bridge. Instead, the storm rerouted the Choluteca River. This rendered the huge, strong and beautiful bridge useless as it served no purpose in the changed environment.

The true potential of healthcare social media has not even been scratched on its surface yet. The focus on cloud computing and Big data can work wonders in the field of medical communications. At Digital MedCom solutions, we currently tag 30,000 Indian physicians via weekly emails and popular social media platforms. Our aim to have an active social database of all 500,000 practicing Indian physicians (or at least the approx. 250,000 active onliners) within the next 2 years is not as farfetched as it may seem. All the stakeholders in healthcare, except the patient, seem to be ignoring social media at present. Unless steps are taken to remedy this inertia, traditional healthcare industry is destined to go the Choluteca Bridge way.

Three Legal tips For Practicing Telemedicine in India

The Internet is now commonplace in India and Healthcare is set to benefit greatly by using internet for our huge and populous country. Telemedicine is one immediate aspect of the web which is set to take off because of the many benefits it provides in the Indian Scenario. A lot of deaths in India are because of treatable diseases like TB, Diarrhea, and Malaria. The doctor: patient ratio at 0.5 per 1000 is way below the desired average of at least 3.0 to 3.5 per thousand. A lot of patients just don’t get to see a doctor. A lot of doctors want to reach out to new populations. Universal Health Coverage will be doable much faster if we can induce Indian Physicians to adopt telemedicine.

But a lot of such Digital Medicine initiatives in India are held up by legal fears. Many of us doctors have no idea of where the law stands in regards to providing health consultations via the internet. For understanding of medico legal aspects of digital medicine, one needs to take a number of acts and regulations under consideration.

1) The Information Technology Act 2000 ;
2) Drugs and Cosmetics Act ;
3) Indian Medical council Act ;
4) Code of Ethics Regulations 2002

In essence, all regulations which apply on real life encounters can be transposed on virtual consults. Following are the three takeaways in non-legalese for Indian Doctors looking to utilize the Internet to better the quality and reach of care they provide:
1) Only medical practitioners registered in India and are allowed to provide medical consultation, prescriptions and treatment. This seems to rule out possibility of foreign doctors providing any web based consultation to Indian patients directly without involving any Indian registered practitioner.

2) Prescriptions created via electronic health records which are digitally signed are acceptable. Most all electronic medical records software provide the secure digital signature ability. There also seems to be no problem with hand written and signed prescriptions on paper which are scanned for digital use and archived for future reference.

3) Automated Prescriptions using Algorithms are tenable as long as the Doctor takes full responsibility for the prescription and accepts to be identified as the originator of the prescription.
Would love to have comments from experts on this.