Relevance and use of the article in UPSC prelims and mains examination: This article is about digitalization of indian health records as Ministry of Health and Family welfare proposes to set up a National e Health Authority (NeHA) responsible for development of integrated Health information System in india.India is mulling over setting up a National eHealth Authority (NeHA) for standardisation, storage and exchange of electronic health records of patients as part of the government’s Digital India programme. The body, to be set up by an Act of Parliament will work on the integration of multiple health IT systems in a way that ensures security, confidentiality and privacy of patient data. On its implementation this would completely revolutionize healthcare in India.
1 The Indian health care system is one of India’s largest and most complex sectors. It delivers services to a diverse population of approximately 1.24 billion across a wide range of geographic and socioeconomic settings. Services are provided by a complex network of public and private care providers, ranging from a single doctor rural PHCs (Primary Health Centres) to specialty and super-specialty healthcare institutions like the medical college hospitals in the public sector and from a single doctor Concept Note- National eHealth Authority (NeHA) outpatient clinic to large trust or corporate hospitals and third party providers in the private sector.
2 India spends around 4.1% of GDP on health, of which only about 1.1% is the contribution of the government. Out of pocket expenses are high at over 60%, much higher than most of the countries in the world. Given that India today enjoys a demographic dividend which can contribute to the productivity and prosperity of the nation, the healthcare system is specially and fundamentally important to the country from both an economic and social perspective. A health population underpins strong economic growth, community well-being and prosperity
3 The Government of India is now scheduled to launch the National e-Health Authority (NeHA). A regulatory body, tasked with overseeing the digitisation of health information, NeHA holds great promise.
National eHealth Authority (NeHA)
1 Mission NeHA will be the nodal authority that will be responsible for development of an Integrated Health Information System (including Telemedicine and mHealth) in India, while collaborating with all the stakeholders, viz., healthcare providers, consumers, healthcare technology industries, and policymakers. It will also be responsible for enforcing the laws & regulations relating to the privacy and security of the patient's health information & records.
Vision / Goals
1. To guide the adoption of e-Health solutions at various levels and areas in the country in a manner that meaningful aggregation of health and governance data and storage/exchange of electronic health records happens at various levels in a cost-effective manner
2. To facilitate integration of multiple health IT systems through health information exchanges
3. To oversee orderly evolution of statewide and nationwide Electronic Health Record Store/Exchange System that ensures that security, confidentiality and privacy of patient data is maintained and continuity of care is ensured.
Change we need:
1 Imagine a health information network where all disparate contributors to health information are allowed to communicate with each other. Thousands of apps that constantly access information from our devices already do this — some with our knowledge, and others without. Our location, phone book, camera, voice, fingerprints, and even our habits and movements are all being tracked. This is facilitated through so-called application programming interfaces or APIs that allow sets of databases or software to communicate with each other.
2 Healthcare APIs would allow the doctor’s iPad to talk to the chemist’s cash register, and lab tests to communicate with the hospital’s database. With selected access to healthcare data, thousands of apps could be developed for patients, doctors, researchers, and policy makers — an app to remind mothers to vaccinate their children, push notifications to remind you to take your medication, or an alert that you are traveling to an epidemic belt. Scientists could search through hundreds of millions of records to find cures and validate current practices, policymakers would be able to conduct disease surveillance and formulate public health interventions, clinicians and patients would have timely access to their records.
3 Patients have not historically been given direct access to their laboratory reports, (usually Corporate Hospitals do not give the reports they end up storing it in their own system( Silos ). Private Stand alone laboratories do give them the report It is not simply an issue of the democratization of medical information, but a recognition that giving information to patients themselves may support communication among labs, physicians, hospitals, and other physicians.
4 Also, a patient gets his Laboratory tests done every time he visits a different healthcare entity, sometimes it is redundant and repetitious, inter connectivity would greatly help solve the problem if the healthcare provider could access the patient’s health record that is stored digitally.
1 Doctors to adopt electronic medical records (EMRs), any proposed systems must be easy to use and affordable.
2 The lack of inter-operability poses another challenge. The highly sequestered systems in US hospitals are not portable and result in duplication of tests and wanton waste.
3 The very lack of entrenched legacy EMRs in India provides a unique greenfield to mandate an API-based ecosystem incorporating inter-operability and standardisation at inception.
Some of the downsides to privacy laws are:
1 Genuine problems with the law for mental health patients and caretakers. The potential inability to share information can be life-threatening
2 Clinical trials: We need to see that Privacy Data Protection laws does not create huge obstructions for biomedical researchers, who need access to large numbers of patient records to assess the efficacy and safety of new drugs and other research priorities
3 It has been claimed that more regulation stifles innovation, particularly in the burgeoning field of mobile health, where designers collect and wirelessly transmit patient data are having trouble meeting privacy and security requirements.
1 NeHA and regulatory laws that define India’s health information landscape will have deep, long-lasting ramifications on healthcare delivery. Giving primacy to the needs of patients and clinicians; adopting human-centered design; abandoning traditional institution-based EMRs in favour of an API-based eco-system; and passing privacy laws in sync with these new technologies, can usher in an era of unprecedented growth in the scope, quality and safety of Indian healthcare.
2 The necessary ingredients are all present: A digital health greenfield, robust telecom infrastructure, unique ID authentication, and a large talented pool of IT professionals. Utilising them may allow India to shape healthcare delivery globally.
1. Health being a state subject in India and much depends on the ability / regulatory framework enacted by the State governments, NeHA shall be created through legislation (Act of Parliament) that empowers it to take leadership and strategic role for setting directions for public and private eHealth initiatives, including electronic health records storage and health information exchange capabilities and other related health information technology efforts & regulation of the same.
2. NeHA shall ensure ongoing interagency cooperation – while engaging with various stakeholders through the Standing Consultative Committee and also through other means, in a structured, open and transparent manner to support successful evolution of national integrated health information system.
The proposed National e-Health Authority, which will oversee digitisation of health information, could launch a digital health revolution in India. But safeguards need to be in place to protect patients’ privacy. Discuss.