ELECTRONIC HEALTH RECORDS

Global and Indian Scenario

Introduction

• An electronic health record (EHR) is a digital version of a patient’s

paper chart.
• EHRs are real-time, patient-centered records that make
information available instantly and securely to authorized users.
• EHRs can Contain a patient’s medical history, diagnoses,
medications, treatment plans, immunization dates, allergies,
radiology images, and laboratory and test results and allow access to
evidence-based tools that providers can use to make decisions about
a patient’s care, Automate and streamline provider workflow.
Definition of ICEHR

“A repository of information regarding the health status of a subject

of care in computer processable form, stored and transmitted
securely, and accessible by multiple authorized users. It has a
standardized or commonly agreed logical information model
which is independent of EHR systems. Its primary purpose is the
support of continuing, efficient and quality integrated health
care and it contains information which is retrospective,
concurrent, and prospective”.

Primary definition of an Integrated Care Electronic Health Record

(ICEHR) according to the ISO TC215/TR20514 document.
Key feature of EHR

• Health information can be created and managed by authorized providers in a

digital format capable of being shared with other providers across more than
one health care organization.
• EHRs are built to share information with other health care providers and
organizations

• Laboratories • Specialists

• Medical imaging facilities • Pharmacies

• Emergency facilities • School and Workplace clinics

EMR & EHR – THE DIFFERENCE

EMR – Electronic Medical Record

Digital version of the paper charts in the clinician’s office.

Contains the medical and treatment history of the patients in one practice.
• Uses:
– Track data over time.
– Identify patients due for preventive screenings or check-ups.
– Check certain parameters—BP, Vaccinations, etc.
• Limitation:
– But the information in EMRs is limited to the institution or the Clinician.
EMR & EHR – THE DIFFERENCE

EHR – Electronic Health Record

Focus on the total health of the patient.

Built to share information with otEHR health care providers.

HIMSS Analytics stated that,

“The EHR represents the ability to easily share medical information among
stakeholders and to have a patient’s information follow him or EHR through the
various modalities of care engaged by that individual.”
ADVANTAGES OF EHR

• Accurate, up-to-date, and complete information about patients at the point of

care.
• Enabling quick access to patient records for more coordinated, efficient care.
• Securely sharing electronic information with patients and other clinicians.
• Effectively diagnose patients, reduce medical errors
• Health care convenience through easier patient – provider interaction.
• Enabling safer, more reliable prescribing.
• Helping promote legible, complete documentation and accurate, streamlined
coding and billing.
• Enhancing privacy and security of patient data.
• Reducing costs through decreased paperwork, improved safety, reduced
duplication of testing, and improved health.
BENEFITS OF EHR

• Improving all aspects of patient care, including safety, effectiveness, patient-

centeredness, communication, education, timeliness, efficiency, and equity.
• Encouraging healthier lifestyles in the entire population, including increased
physical activity, better nutrition, avoidance of behavioural risks, and wider use
of preventative care.
• Improved efficiencies and lower health care costs by promoting preventative
medicine and improved coordination of health care services, as well as by
reducing waste and redundant tests.
• Better clinical decision making by integrating patient information from
multiple sources.
The Global Scene

According to a new market report published by Transparency Market Research

“Electronic Health Records (EHR) Market - Global Industry Analysis, Size, Share,
Growth, Trends and Forecast, 2014 - 2020,”
 Electronic Health Records (EHR) Market Expected to Reach USD 23.98
Billion Globally in 2020.
 Global EHR market was valued at USD 15.56 billion in 2013.
 Expected to grow at a CAGR of 6.4% from 2014 to 2020.
 Reach an estimated value of USD 23.98 billion in 2020.
The Global Scene
Survey in Europe – Use of EHR

No Yes, Asst.Health insurance, physicians

Yes Purchased specifically Yes provided by health authorities
EHR Market Segmentation

By Installation By End User By Geography

• Web Based • Hospital • North America
• Client Server Based • Physician Office • Europe
• SAAS • Ambulatory Centres • Asia Pacific
• Rest of Asia Pacific
• Rest of the World
By Geography - Detailed
North America Europe Asia Pacific Latin America Rest of the World
• United States • United Kingdom • India • Brazil • Israel
• Canada • Germany • China • Mexico • Russia
• France • Australia • Argentina • South Africa
• Rest of Europe • Malaysia • Rest of Latin America • Saudi Arabia
• Japan • Rest of the World
• Rest of Asia Pacific
EHR vendors market share

1. All scripts 4%
2. Cerner Corp 16%
3. CPSI 7%
4. Epic Systems 22%
5. Healthland 3%
6. MCKesson 8%
7. MEDHOST 4%
8. MEDITECH 17%
9. NextGen 1%
10.Proprietary software 4%
11.Siemens 5%
12.Other 9%
EHR/EMR trends in the US…
EHR by End Users
 THE
INDIAN
CONTEXT
Current Scenario

 Low penetration of HIT in India as compared to developed countries like the

US. But growing steadily.
 The total spending on IT by the US hospitals in 2011 - $79-80 billion /
Healthcare IT spending of $305 million in India.
 EMR market growing at 13.5 per cent per annum.
 India’s healthcare information technology market is expected to reach $1.45
billion in 2018, more than three times the $381.3 million reached in 2012 -
Frost & Sullivan.
 Over 120 vendors with small to large scale offerings with variety of web based
and client side products.
 Approximately 35 domestic EMR vendors in India with multiple product
portfolios.
Top Challenges for EMR in India

• Underfunding of public healthcare services.

• Limited knowledge about applications of IT.
• Shortage of trained manpower.
• Huge initial investments and Lack of stringent regulations.
• Hospitals and doctors control patient information and medical records.
• No strong legislations to support patient rights.
Opportunity for EHR products/services

• Growing demand for Health intervention choice

independence by Educated citizens. Reasons: Rise of
Lifestyle Diseases, Nuclear Families, Rural to Urban
migration, Growth in health Insurance.
• Shift from Clinician/Hospital centric Medical Record to
Patient Centric Health Record. Preferred Practitioners
and Second opinions.
• Demand by patients for Electronic Personal Health
Record access.
• Few dedicated players for EHR. Most players are EMR
with EPR (Electronic Patient record) incorporated.
• Shift towards Cloud based/SAAS as against Client
Server and Dedicated Server technologies.
• Institution of Standardization of Electronic records by
MOHFW, GOI through NeHA.
NeHA – National e-Health Authority
• Released in August 2013
• Defines Electronic Health Record Standards
for India
• Contains instructions on:
o Interoperability and Standards.
o Guidelines: Hardware, Networking and
Connectivity, Software Standards, Proposed
Mobile health Record.
o Data Ownership of EHR.
o Data privacy and security.
o EHR minimum data sets.
o Formats for medical records.
Product opportunities for RIL
With the tangible shift to Cloud based
services, the following products are
making their way into the market.

1. SAAS – A portal where Personal

webspace to store EHR Data
provided to patient for a price. -
Controlled Access, Data ownership
given to Patient, Security and
anonymity ensured.
2. EHR Card – Similar to Adhaar
Card, PAN card or Arogyasree Card.
- Single portal for all medical
encounters of a patient from PHC
to Apex hospital encounters /
transactions.
RIL Strengths

• Healthcare background - Sir H. N. Reliance Foundation

Hospital and Research Centre
• Experienced IT wing with Reliance Jio already launched.
Launching 4G network.
• Large employee base for internal product testing and
trouble shooting.
• Pan-Indian Presence - Multiple sectors and product lines,
distribution network in place.
• Mind-space of Indian Customer.
Points to consider for EHR

General Requirements

• RBAC – role-based access control

• Digital signature
• Audit trail
• Accurate transcription
• Error-free transmission
• Ability to display data in an informative manner – textual & graphical

Approved Standards: Codes

• Clinical Terminology (for clinical observations) –IHTSDO’s SNOMED CT

• Laboratory Observations –Regenstrief Institutes LOINC
• Diseases (Diagnosis) –WHO’s ICD 10
• Procedures –WHO’s ICD 10 PCS
• Disability –WHO’s ICF
Points to consider for EHR

Approved Standards: Others

• Messaging
• HL7 V3.0 RIM (Reference Information Model)
• HL7 V2.5 (for backward compatibility)
• Imaging - a. NEMA’s Digital Imaging & Communication in Medicine (DICOM) PS3.0-2004, b.
Later revisions can be included as evolved
• Clinical Data Format - a. HL7 CDA 2.0 (Clinical Document Architecture), b. ASTM CCR
(Continuity of Care Record)

Minimum Data Set

• Patient Demographics ; Observer Details ; Reasons for visit ; Allergies & Immunization; Clinical
Observations ; Investigation Orders; Laboratory, Radiology ; Medication ; Treatment Plan ;
Investigation Result ; Procedures ; Diet ; Life-style ; Outcome ; Date- time Stamp
Points to consider for EHR

EHR Security Mechanisms

• Authentication ; Role-Based Access Control; Data Verification;

Transport Level security ; Encryption Mechanisms;
Data/Storage; Audit/Log; Anonymisation

Ethical and Legal Considerations

• Data Retention Policy; Patient Policy/Confidentiality ; Patient

Consent ; Quality of Service (QOS) ; Data Ownership: Patient is
the owner, provider is the custodian ; Non-repudiation ;
Dispute Resolution
Closing remarks

• EMRs started the trend and now EHRs are the next step.
• Growing demand and a great scope for supply.
• Data portability, SAAS / Cloud services = strong and viable
market for integrated, inter-operable, inclusive and interactive
EHR Application.
• USP and Delight factors to attract the audience.
• Multiple Beneficiaries : The patient and The clinician –
portability and accessibility ; The specialist - remote
consultation across borders ; Medical colleges and Research
institutions - data is teaching and research material.
References:

• Digital India programme: Govt mulls setting up eHealth Authority; It will be responsible for the plan’s implementation by both public
and private service providers.
• Concept Note - National eHealth Authority (NeHA)
• Healthcare // Electronic Health Records; 17 Leading EHR Vendors
• What are the advantages of electronic health records _ FAQs _ Providers & Professionals _ HealthIT.gov
• The Benefits of Electronic Health Records (EHRs) _ Providers & Professionals _ HealthIT.gov
• References _ National Health Portal of India
• Interoperability and Standards _ National Health Portal of India
• Increase Patient Participation in Care with Health IT _ Providers & Professionals _ HealthIT.gov
• Improving Patient Outcomes and Diagnostics with EHRs _ Providers & Professionals _ HealthIT.gov
• Improved Healthcare Quality and Convenience with Health IT _ Providers & Professionals _ HealthIT.gov
• Improve Medical Practice Management with Electronic Health Records _ Providers & Professionals _ HealthIT.gov
• Guidelines _ National Health Portal of India
• Global Electronic Health Records (EHR) Market to Reach US$30.28 bn by 2023
• Executive Summary _ National Health Portal of India
• EMR Market in India_ Growth and Challenges _ Article _ GreenBook.org
• Electronic Health Record Standards For India Helpdesk _ National Health Portal Of India
• Data Privacy and Security _ National Health Portal of India
• Data Ownership of EHR _ National Health Portal of India
• Approved EHR Standards for India
• Categories for Adoption of Standards _ National Health Portal of India
Thank You