Digital health is about electronically connecting the points of care so that health information can be shared securely. This is the first step to understanding how digital health can help deliver safer, better quality healthcare. Digital health includes mobile health, health information technology, wearable devices, telehealth and telemedicine and personalised medicine.
The cornerstone of digital health is Electronic Health Record (EHR) – a digital version of a patient's medical record. EHRs are real-time, patient-centric records that make information available instantly and securely to the authorised users. While an EHR does contain the medical and treatment histories of patients, an EHR system goes beyond standard clinical data collected in a provider's office and can be inclusive of a broader view of a patient's care.
Contain a patient's medical history, diagnoses, medications, treatment plans, immunisation dates, allergies, radiology images, and laboratory and test results
Allow access to evidence-based tools that providers can use to make decisions about a patient's care
Automate and streamline provider workflow
Automatic integration of EHR systems and intravenous medication infusion devices equipped with dose error reduction software (drug libraries) is termed intravenous (IV) interoperability. This should serve as the goal towards which all healthcare systems work to maximise patient safety.
Complete circle of benefits
Standardising healthcare information technologies along with regulatory reform must be the primary drivers of increased EHR adoption in India. To realise the full benefits that EHR solutions can deliver, medical organisations must carefully plan their EHR implementation to achieve optimum utilisation. Only then will these organisations achieve the improvements they desire, and, ultimately, realise a positive return on their technology investments.
The Ministry of Health and Family Welfare has already enlisted the desirable standards for exchange of health information. The second edition of the standards was notified in December 2016. Further, an Integrated Health Information Platform (IHIP) is being set-up for the interoperable exchange of health information.
National Health Policy-2017
National Health Policy-2017 advocates the extensive deployment of digital tools for improving the efficiency and outcome of the healthcare system. The policy aims at an integrated health information platform or system to serve the needs of all stakeholders and improve efficiency, transparency and citizen experience.
The delivery of better health outcomes in terms of access, quality, affordability, lowering of disease burden and efficient monitoring of health entitlements to citizens is the goal. The policy underscores the need for establishing a federated national health information architecture to roll-out and link systems across public and private health providers at the state and national levels consistent with Metadata and Data Standards (MDDS) and EHR standards.
Creation of registries (i.e. patients, provider, service, diseases, document and event) for enhanced public health and big data analytics, creation of a health information exchange platform and national health information network, the use of National Optical Fiber Network (NOFN), and the use of smartphones for capturing real-time data, are key strategies of the National Health Information Architecture.
NHP-2017 advocates the scaling of various initiatives in the area of teleconsultation, which will entail linking tertiary care institutions (medical colleges) to district and sub-district hospitals which provide secondary care facilities for the purpose of specialist consultations.
Implementing an EHR is not a straightforward process, and a "one-size-fits-all" approach is ineffective since numerous variables exist in every practice. An optimised implementation will make the difference between an EHR that drives improvements in efficiency and care delivery, versus an EHR that is abandoned or even replaced.
Areas of EHR implementation include:
Securing physician leadership
Setting realistic expectations
Adequate, appropriate documentation
Acceptance of evolving staff roles and responsibilities
Cost components would circumscribe:
Software licensing (outright purchase, leasing and/or monthly subscription fees)
Hardware expenses, depending on the age or capabilities of current equipment
Configuration and customisation
Support and maintenance
Potential lost productivity that impacts revenue during implementation, training and initial use of the system
For an EHR to be successful, it must maximise clinician efficiency and an emphasis on performance (availability and speed) will have to be in place. It must be remembered that EHRs are not stand-alone systems but are 'systems of systems'.
While the long-term benefits of EHRs are being evaluated, patient portals are a beacon of encouragement. As a single component or complement to an EHR that helps achieve better care, better health, and reduced costs, the patient portal can drive significant value. Optimally deployed with self-service identity management tools, health systems can magnify the importance of their patient portals to enhance patient loyalty, increase enrollment and utilisation of targeted patient groups, and increase the quantifiable clinical and financial benefits for patients and providers alike.
HIM: The Way Forward
Health Information Management (HIM) professionals are well trained in the latest information management technology applications with an understanding of the workflow. Health Information Managers are vital to the daily operations management of health information and EHRs. They ensure that data quality is maintained by applying the principles of change management and continuous capacity building through education and training. They ensure that the health information and records of a patient are complete, accurate, protected and meet the desired and stipulated medical, legal and ethical standards. Therefore, it must be made mandatory to appoint an adequate number of Health Information Managers, according to the size of the healthcare organisation, to ensure safe and smooth adoption of digital health in India, leading to informed and safer healthcare delivery.
(Professor Supten Sarbadhikari is Dean at International Institute of Health Management Research, Delhi. Views expressed are strictly personal)