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 center 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.
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Author: Ranjeeta Basra Korgaonkar