Healthcare IT in India

Dr A Thanga Prabhu (thangas@gmail.com)

Introduction:
The huge advances made in the fields of Information Technology provide an
opportunity to solve many of the problems faced in healthcare delivery in India in
2011. Healthcare IT is a powerful tool and but to be successful it needs to be
accepted by providers (doctors, nurses and other healthcarers). The huge benefits
that will ensue adoption of this modern way of delivering care needs to be explained
to patients who are the receivers of that care. Management support is essential
throughout the cycle of implementation to ensure success.

Indian Healthcare System:

British NHS (national health services) model has been adopted in India post
independence in 1947. It is a socialist model with healthcare provided as a service
free at the point of care funded by taxpayers. Health is today a state subject and
healthcare delivery is within the mandate of the State Governments. Government of
India is a regulatory and supervisory body with overall control on Medical education
and Medical research in addition to infectious disease monitoring across India. They
also provide funds through NRHM (National Rural Health Mission).

Indian healthcare underwent a massive transformation in the 1980s with corporate

hospitals emerging in urban India. These hospitals for a fee deliver world-class
health services and are almost exclusively concentrated in the cities. The advanced
capability that these hospitals have acquired is evident from the fact they are
accredited by international standards bodies such as JCI (Joint Commission
International), ISO (International Standards Organization) and NABH (National
Accreditation Board for Hospitals and Healthcare providers). Relatively lower cost of
health care, as compared to developed countries, coupled with international quality,
has positioned India as a major destination for health care services.

The change from hospital to home based care:

There is a tendency in the western world to move from hospital based to home-
based care today. Better and more effective antibiotics mean patients don’t have to
stay in hospital for treatment of most illnesses. MRSA (methicillin resistant
staphylococcus aureus) added to making home-based treatment preferable to being
an inpatient (MRSA and other hospital acquired infections are almost impossible to
treat with known antibiotics and result in great morbidity and mortality). The elderly
population (whose numbers are increasing as a ratio of the population) will benefit
most from such home-based treatment. It is making more economic sense to be able
to provide the services of specialists, to as many as possible, in such fields as
Dermatology, Radiology and Pathology. The study done by Gustke and colleagues
has evaluated patient satisfaction in using telemedicine for home based care and
concluded positively (Gustke et al., 2000). PHR (personal health records) are
emerging where patients own, maintain and decide on whom their medical records
are shared with. Online consultation and telemedicine for accessing specialist
services are already being offered in India today.

Clinicians are adapting to the increasing presence of technology and HCIT in their
every day practice. Radiologists, dermatologists, psychiatrists, cardiologists and
pathologists are some of the specialists who are early adopters.
Healthcare IT experience in USA:
HITECH (Health Information Technology for Economic and Clinical Health) act passed
by the US Government in 2009 has catalyzed the adoption of healthcare IT with a
massive infusion of funds (USD 20 billion). Strategic Health Information Technology
Advanced Research Projects (SHARP) funds research focused on achieving
breakthrough advances to address well-documented problems that have impeded
adoption of HIT, including:

 security of HIT
 patient-centered cognitive support
 health care application
 network-platform architectures
 secondary use of EHR data.

HITECH Act programs and regulations address the most pressing obstacles to the
adoption and meaningful use of EHRs and strive to create an electronic circulatory
system for health information that nourishes the practice of medicine, research, and
public health, making health care professionals better at what they do and the
American people healthier. Office of the National Coordinator for Health Information
Technology (ONC) has made significant strides in implementing components of the
HITECH Act by launching innovative programs that have already awarded nearly
$800 million in grants.

Nationwide Health Information Network (NHIN) is a common platform for health

information exchange across diverse entities, within communities, and across the
country to promote a more effective marketplace, greater competition, and increased
choice through accessibility to accurate information on health care costs, quality, and
outcomes. Standards and Certification are key to achieving this vision and hence
interoperability specifications are being developed that identify harmonized standards
and provide detailed technical specification for how those need to be used and also
work with healthcare organizations and SDO (standards development organizations)
to ensure that standards are available for use across USA.

Potential Benefits of Health IT

• Quality of care for individual patients. Patients will receive better medical
care if they and their healthcare providers have access to complete and
accurate electronic health records that aggregate information across time and
organizations. Given the fragmented nature of the U.S. healthcare system,
such integrated health records are now often not available. Such records
could improve diagnoses, prevent errors, and save time.
• Engagement of patients in healthcare. The participation of patients in their
own healthcare could substantially improve their care, especially in the management
and treatment of chronic conditions such as obesity and diabetes. Access to
electronic personal health information and interfaces that make it easy for public and
private clinical organizations to share health information with each other and with
patients could enable healthcare providers and patients to collaborate in informed
decision-making.
• Clinical studies of medical interventions. Sound medicine needs to be based
on empirical evidence of how well particular interventions work for patients. While
some questions can only be answered through randomized clinical trials, a
tremendous amount could be learned through the ability to integrate the combined
experience of millions of patients. Aggregated de-identified information could enable
a wide range of studies on such topics as the efficacy of prevention strategies, the
frequency of particular complications in particular settings, and the response of
individuals to specific drugs as a function of genotype.
• Improved population-based knowledge. Aggregated health information can
provide invaluable tools for identifying and tracking medical events such as
epidemics and adverse events related to treatment.
• Development of new tools for medicine. In most industries (such as retail
consumer goods, shipping, and financial services), the availability of electronic
information has led to an outpouring of creative tools that have increased quality and
enabled new kinds of services. Healthcare could benefit greatly from such tools.
Examples include home-based monitoring devices that could directly transmit data to
physicians, systems that could help increase patient compliance with drug regimens,
and computerized decision support systems able to incorporate the most up-to-date
clinical knowledge.
• Increased administrative efficiency. In most industries, electronic information
also has led to a decrease in administrative costs as many processes became
automated. In healthcare, administrative tasks (such as filling out forms and
processing billing requests) represent a significant fraction of healthcare costs.
Health IT could streamline these tasks and significantly decrease costs.

Data Protection:
The Privacy and Security Rules issued under the Health Insurance Portability and
Accountability Act (HIPAA) of 1996 provided the first broadly applicable Federal
protections for health information in USA. Emerging capabilities now in metadata,
encryption, and identity systems enable promising new ways to protect Internet-
based information that were not envisioned when HIPAA was passed.

Are HIS/EMR needed in India?

Health Care sector in India has witnessed significant growth during the last few
years, both in quality and capacity. Innovative systems are required for quick
reporting of diseases when they occur and to implement an effective system of
intervention to provide the best diagnostic and medical care to the affected patients
and prevent further spread of the disease. India also has a strong base for medical
research. Extensive work is being done as a part of postgraduate work in medical
institutions, ICMR labs and other institutions. There is, however, a strong need of
sharing of knowledge and resources amongst the researchers and healthcare
providers.

Private sector has initiated massive investments in various facets of healthcare. This
is expected to position health care as one of the largest service sectors and a
significant contributor to the GDP. As the health sector is poised for major growth in
next decade, the sheer size of healthcare sector in the country will necessitate
extensive use of Healthcare IT infrastructure, services and databases for policy
planning and implementation. Such a framework would require services based on
inter-operable and shareable technology, connecting various institutions and service
providers.
Knowledge Dissemination and Public Health, Health Care Planning, Natural Disasters,
Bio-Terrorism, Drug Surveillance, Fraud and Abuse Prevention, Medical Errors are
some of the areas identified as key to be addressed. This mammoth task is not
without challenges; some of them are Leadership, Standards, Connectivity, Privacy
and Security, User Needs/ resistance to change, ICT and Domain Knowledge and
Funding.

A group of volunteers worked together virtually for six weeks in 2010 and produced a
HIN (health information network) plan as part of iHIND. IHIND is an abbreviation for
Indian Health Information Network Development and derives from work done by
NKC (National Knowledge Commission) to address the healthcare IT needs of India.
It has three components:

 IHP – India Health Portal (to provide health information & education)
 NEMS – National Emergency Medical Services
 HIN – Health Information Network

Health Secretary of India has subsequently formed the ‘EMR Standards’ expert
committee to study existing ‘EMR interoperability standards’ and identify those,
which are needed for India. SnomedCT, ICD10, HL7, CCD/CCR (continuity of care
document/ record), CDA are some of the standards that are being studied closely.

The trend in India has been to leapfrog and adopt the latest technology without
undergoing the long, painful, risk prone and costly adoption rigmarole of early
adopters. Healthcare IT is following the path successfully taken by
telecommunication a decade ago, as a result of which we are using the best that
telecommunications technology has to offer in India today.

References:
http://www.knowledgecommission.gov.in, accessed 10 Feb 2009
http://www.whitehouse.gov/sites/default/files/microsites/ostp/pcast-health-it-
report.pdf, accessed 20 Jan 2011
http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__home/1204,
accessed 20 Jan 2011
Alvarez, R. (1995), 31-33. Lisbon Telemedicine Conference proceedings.