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India

In March 2014 India became a Member, joining a global effort to develop, maintain, and enable the use of SNOMED CT in health systems around the world.

The healthcare sector in India has witnessed significant growth during the last few years, both in terms of quality and capacity. However, easy accessibility to quality healthcare and affordability for the citizens at large continue to remain our key concerns.

The Indian healthcare system is diverse in nature.  At one end of the spectrum there are single doctor clinical establishments, on the other end there are large public and private sector super-speciality hospitals.

The large corporate hospitals are increasingly moving towards maintaining electronic health records (EHR) of their patients.  However, these systems are highly fragmented and use multiple information technology systems. Consequently, a patient’s health information often gets trapped in silos of legacy systems, unable to be shared with other system and establishments.

Recognizing this and to encourage standardization, integration and electronic information exchange amongst the various healthcare providers and recognising that the electronic collection, storage, processing and transmission of personal health data require adherence to the highest standard of data protection, Ministry of Health & Family Welfare, Government of India (GoI) decided to frame “EHR Standards for India”. 

The EHR standards were formulated after extensive discussion with all the stakeholders and thereafter notified by the GoI in September, 2013.  Some of the approved standards prescribed in the EHR Standards for India include WHO International Classification of Diseases (ICD) 10, SNOMED CT, Logical Observation Identifiers Names and Codes (LOINC), Health Level 7 (HL7), NEMA’s Digital Imaging & Communication in Medicine (DICOM), Clinical formats such as  HL7 CCD (Continuity of Care Document).

The Ministry of Health and Family Welfare has decided to facilitate and promote adoption of the standards voluntarily and in a phased manner.  Government of India (GoI) runs a scheme called Central Government Health Scheme (CGHS) to provide health care facilities to its employees, both serving and retired.  More than 400 private hospitals are empanelled under the scheme.  Adoption of EHR standards has been made a pre-condition for empanelment of hospitals under the scheme, thereby ensuring adoption of EHR standards by a large number of hospitals in different parts of the country.

The Government of India (GoI) is also in the process of Standardising Codification for Health Procedures in India and framing Metadata and Data Standards (MDDS) for health sector. MDDS will facilitate interoperability of e-Governance applications by providing a common data information model for various stakeholders in the health system – national and state, public and private, to begin sharing meaningful information with each other in a timely manner.

The Government of India (GoI) has recently procured the SNOMED CT license for India and is offering it for all healthcare professionals and vendors of India at no cost to promote adoption and implementation by the private sector.

The Government of India (GoI) also intends to set up a mechanism to monitor and evaluate the implementation of and adherence to EHR Standards and Guidelines by the various healthcare practitioners and vendors. To this end, it plans to set up a central authority/agency/body to check compliance of the standards in EHR ecosystem after due consultation with various stakeholders across the spectrum.

There are many IT systems already operating on a ‘standalone’ basis at the federal level and in the States.  Hence, there is a need to achieve convergence amongst various IT systems in the health sector to provide services to various stake-holders in a robust and efficient manner, obtain reliable information for policy making, ensure efficient program & service delivery and provide timely response in the event of disease outbreak.

In order to understand the macro picture of eHealth initiatives across the country, find gaps in the implementations, and avoid duplication of effort and to replicate the best practices, a Core Scoping Study was carried out for identifying potential areas of action on eHealth and a Detailed Project Report (DPR) is being prepared for a Health Mission Mode Project in India. The goal is to devise a strategy on how ICT intervention can help in transforming healthcare system with the aim to improve patient and public health outcomes by improving the accessibility and quality of healthcare services.

Going forward, the DPR for Health MMP will outline the five focus areas of service delivery namely Hospital Information System, Citizen Portal, Supply Chain Management, Government Resource Planning and Integrated Public Health Solution. The DPR will also provide framework for the Regulatory Structure, Implementation Mechanism, financial and institutional framework along with future roadmap for eHealth & m-Health initiatives across the country.

Under the Hospital Information System, it is envisaged that it will integrate and maintain health records for individuals ultimately covering the entire nation while addressing the issues of efficiency, transparency, ease of storage and exchange of patient records between different systems leading to reduction in health care cost, service delivery time and errors.

The Citizen portal for health aims to provide information and services to the public to enhance their experience and to serve as a single point of access for consolidated health information and services.

An integrated supply chain management system is planned that could ensure visibility of information across the chain, streamline processes and ensure greater coordination, productivity of demand and supply at all levels and stakeholders in the system and delivers products/services to the intended beneficiaries.

In order to deal with the continuous drastic change in healthcare spending and major demographic change, the government is aiming at improving the efficiency and the quality of care services provided to citizens. A government resource planning focus area will outline the functionalities and key elements to a successful system.

The Integrated Public Health Solution for an integrated solution across the various national health programs and healthcare facilities. It is expected to suggest ways to improve accessibility obviate duplication of data collection and improve data management and reporting.

The Government of India believes that the health standards should be “patient-centric” to bring efficiencies, improve professionalism in service delivery and strengthen the healthcare system.  Standards should be implementable by large, small, public or private establishments without any difficulty.  Moreover the standards should be globally aligned, interoperable and compatible with the efforts in the pipeline to develop/update standards by the World Health Organisation (WHO) and other international bodies.

 

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