eHealth Conference 2012 Gaur Sunder
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Transcript of eHealth Conference 2012 Gaur Sunder
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Developing Developing eHealtheHealth Strategies to Strategies to
Deliver an Effective EHR SystemDeliver an Effective EHR SystemIndia Case StudyIndia Case Study
Gaur SunderMedical Informatics Group
C-DAC, India
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AgendaAgenda
• Introduction & Background
• Issues & Challenges
• Strategies
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INTRODUCTION & BACKGROUNDINTRODUCTION & BACKGROUND
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Indian Healthcare ScenarioIndian Healthcare Scenario
• Tiered Rural and Urban Healthcare System
• Doctor Patient ratio at 1:2000 (average)
• Robust network of private healthcare providers and ancillary services
• Private sector share a large load and service profile (about 50%~70%)
• Majority of medical graduatesare provided by public system(about 80%)
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EHR/EMR Systems in IndiaEHR/EMR Systems in India• Scant but few at District level and above have
some HIS/HIMS or system
• Most public/private large setups have functional HIS/HIMS, some of them have internal EMR/EHR capability
• There is no mandated functional interoperable EMR/EHR at any level
• There are several Telemedicinesetups but mostly withoutEMR/EHR constructs
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Building National EMR SystemBuilding National EMR System
• Union Ministry of Health has started
consultation for building National EHR System
• Few steps already taken:
– National EHR Standards Committee by MoH&FW
– Technology Prototype for scalable, reliable
healthcare repository by MoC&IT
– National Knowledge Commission
project iHIND
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ISSUES & CHALLENGESISSUES & CHALLENGES
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EHR Data SourcesEHR Data Sources
• Application Communication Protocol
• Device Communication Protocol
• Database Schemas
• Structured Data Transmission
• XML Mapping Schemas
• Medical Informatics Standards
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Medical Standards: Current ScenarioMedical Standards: Current Scenario
• EHR Standards
– EHR Content Standards
– Content Exchange Standards
– Codes, Terminologies, Vocabularies
• “Proprietary” Data Representation
– Local Data Formats
– Local Clinical Data Standards
– Local Codes, Terminologies
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Problem of PlentyProblem of Plenty
• No single comprehensive Standard,
Terminology, Coding System
• Content-based selection of Standards
• But Standards change too!
– Dependency on evolution, changes in Standards
– Localization of existing Standards, Terminologies,
Codes
– Change in version also costs to implement/adopt
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Regulatory EnvironmentRegulatory Environment• No regulation towards enforcing selected eHealth
Standards
• Comprehensive mechanism for regulation of healthcare, etc. but none for eHealth
• Work on since 2003 by IT Ministry and Health Ministry to find an acceptable set of standards
• ICT penetration, where available, in Healthcare is focused on operations and not clinical information
• Unfortunately, most of HIS/HIMS in useare not designed to maintain clinical data,most don’t follow any establishedeHealth standards
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Identification & Duplication Identification & Duplication • India has begun to allot Unique National
Identification Number – Aadhar, to citizens
• There are plethora of IDs given by Government Agencies at Rural, District, State, National, and Service levels
• All Healthcare system have their own ID assignment policy
• Due to illiteracy and time-constraintsduring data-entry, the demographicrecords captured are unreliable orduplicated
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STRATEGIES TOWARDS BETTER STRATEGIES TOWARDS BETTER
HEALTHCARE SERVICESHEALTHCARE SERVICES
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Identification & DuplicationIdentification & Duplication• Where UID available, system should readily use it
• Where not, then you have plethora of IDs but
– IDs are by nature unique
– Degree of Uniqueness varies on Zone of system implementation
• Maintain a ID Relationships to match records
• Search and Identify possible duplication, and:
– Preferably, prevent duplication
– Or allow merging of records by records keeper
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Learn from National EHR ProgramsLearn from National EHR ProgramsCountry National EHR Program
Australia HealthConnect
Austria ELGA
Canada EHRS Blueprint
Denmark MedCom
England Spine
Hong Kong eHR Infrastructure
India *Recommendation Stage*
Netherlands AORTA
Singapore NEHR
Sweden National Patient Summary (NPO)
Taiwan Health Information Network (HIN)
United States of America EHR Meaningful Use
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Need of the HourNeed of the Hour
• Building today’s Model
of EHR
• Multiple Data Source
integration
• Many Standards,
Multiple data formats,
Single Solution?
HL7openEHR DICOM CCR
CCD
EHR
*
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Addressing ProblemsAddressing ProblemsConcerns Solution Approach
Multiple patient identities Maintain ID Relationships
Incomplete EMR/EHR Cover complete EHR phases/artefacts
Geographical spread Design for single/distributed/cloud environment
Solution Scalability Highly scalable architecture
Multiple Standards Multi-standard support
Fail-safety/Redundancy Distributed/Clustered design
Performance Efficient operations
Design and Integration Flexibility API for integration with healthcare applications
Security Integrate Security Framework
Large Data-set Efficient storage management
Vendor Lock-in Build on Open systems
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DHS: Overall System ArchitectureDHS: Overall System Architecture
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OfferingOffering• Highly redundant, fail-safe, secure system framework
• Works as EHR integrator from various sources
• Requires little or no change in your current systems:– Only add as additional underlying layer
– If schema is shared then non-standard system could be supported
– Requires NO change in workflow, database, application logic
– If not supporting certificates, then stop-gap arrangement is possible
– Will require marginal change in User management part
– Users are obvious to addition
– However, tighter integrations are possible using EHR-API
• Can be used for Interoperability, Telemedicine, Referrals, Emergency
• Any number of consumer application can be built on top
• Can be extended further to meet specific requirements
• OLAP services can be build on top
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ChallengesChallenges
• Integration of existing health data in
proprietary format into the Distributed
Store
• Evaluating the Distributed Healthcare
Information store in diverse conditions
• Absence of Unique Patient/Citizen
Database
• Willingness of Medical organization /
individuals in participating
• Adoption by
ISV/OEM/Applications/Services
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Proposal: Get it workingProposal: Get it working• Work towards promoting eHealth standards
• Increase ICT penetration:– Government Programs, Incentives, Regulations
– Support with affordable technologies
– Utilize available affordable hardware
• Bring in regulatory/control body for managing National Health Repository (NHR)
• Incentivize interoperability and connecting to NHR
• Promote interoperability between Private-Private, Private-Public referral system
• Demonstrate in public healthcare system and invite all to join; start with Hospitals, migrate to ancillary providers