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Health Informatics Standardisation in Indian Healthcare

Dr. Baljit Singh Bedi
Advisor, Health Informatics, Ministry of Communication & IT(GoI)

Understanding Information and Communication Technologies (ICTs)

•Healthcare area is highly Data dependent. Power of ICTs lies in its capacity to effectively
•Access data
• Store data
• Analyze data
Transmit data

Utilizing this  capability of ICTs has the potential to significantly  contribute in preventive care, improving delivery , disease control , medical education and training,  health management and health research.

Role of ICTs in Health sector owes its contribution to  Advances  in cost and capability to its components:

These advances have deeply impacted key areas  of:

§Health Management Information System (HMIS) –  supporting Epidemiological & Disease surveillance
§Hospital Information Systems- With challenge to build a system that allows   case records to be maintained and updated in electronic format, and from this cull out data required for improved hospital management and clinical quality of care
§Telemedicine /Tele-education solutions  for remote quality consultation-the area includes e-Health, m-Health

The Need for Standards for eHealth

•A set of guidelines/standards  optimally leverages existing technologies, ensure continuity to evolving technical innovations and deliver cost effective solutions and sharing medical knowledge
•Would  help indigenous enterprises provide the right platform for eHealth and further provide all with a practically attainable and sustainable standard of health care
•To provide a framework for interoperability and scalability across eHealth/mHealth services within the country and outside
•Electronic Health Record(EHR) is one of the most important parameter in eHealth standardisation

Key considerations in  Defining Guidelines & Standards

Usability

Reliability

Compatibility

Interoperability

Scalability

Portability

Ensuring:
§Inclusion of all the stakeholders
§Making recommendations vendor neutral
§Making standards technology neutral

An Example of Accepted Multi Media Tele-conferencing Standards

The International Telecommunications Union (ITU)-T   T.120, H.320,H.323,and H.324 standards comprise the core technologies for multimedia teleconferencing (video conferencing).

§ The T.120 standards address Real Time Data Conferencing (Audiographics),

§The H.320 standards address ISDN videoconferencing,
§ The H323 standard addresses Video (Audiovisual) communication on Local Area Networks,

§The H.324 standard addresses High Quality Video and Audio Compression over POTS modem connections.

Issues that would get addressed?

•Security
•Standards
•Authentication
Reliability

•Regulatory framework
•Competition
•Legal issues
Procedural issues

•Implementation bottlenecks
•Universal accessibility issues
•Education and training
Conflict of interest

What is EHR?

—A repository of information regarding the health of a subject of care in computer processable form —Stored and transmitted securely, and accessible by multiple authorized users
—It has a commonly agreed logical information model which is independent of EHR systems
—Purpose is the support of continuing, efficient and quality integrated health care and it contains information which is retrospective, concurrent and prospective

Significance of EHR

•Paperless medical history
•Reduce healthcare costs
•Right treatment at Right time
•Promote evidence-based medicine
•Accelerates Research and building effective medical practices

EMR Standards Committee of MoHFW

•Ministry of Health & Family Welfare (MoH&FW), Govt. of India  constituted a Committee of Experts  for Development of Standards on EMR in Sept
•Objective of above Committee to recommend a set of EMR Standards for India to be followed by both public & private healthcare provider
•Procedure for continuous up gradation

Activities Undertaken

►EMR Standardisation Committee set up following Sub-Groups in October 2010:
►Sub-Group Task I : Standards- Terminology, coding standards
►Sub-Group Task II : Data connectivity- including H/W,S/W & Interoperability
►Sub-Group Task III: Data ownership-Data protection& including security and legal aspects
►The current EHR standards are a result of the deliberations of the EMR Standards Committee & Subgroups and consolidation by the Sub-committee under FICCI of the public comments on the draft report put up by MoHFW, GoI in their website in May 2013 and deliberations thereof, finalized in August, 2013.
►Notified in September, 2013 on MoH&FW Website
►National Implementation Committee has been set up

Approved Standards:
Codes

•Diseases (Diagnosis)
–WHO’s ICD 10
•Procedures
– ICD 10 PCS
•Disability
–WHO’s ICF

•Clinical Terminology (for clinical observations)
–IHTSDO’s SNOMED CT
•Laboratory Observations
–Regenstrief Inst’s LOINC

Messaging, Imaging, Clinical Document Format

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

Minimum Data Set (MDS)

•Minimum amount of health information required about a patient to profile a disease in a standard format.
•Ensure that the health information is precise, unambiguous and acceptable to all stakeholders.
Represented in such a manner that they can be easily analysed and conclusions drawn from the data.

EHR-Preservation, Ownership & Security Guidelines

•Purpose:
–To protect the confidentiality, integrity, and availability of information
•Threat Sources:
–Accidental Acts: Incidental disclosures, Errors and omissions, Proximity to risk areas, Equipment malfunction
–Deliberate Acts: Misuse/abuse of privileges, Fraud, Theft, Extortion, Crime
Environmental threats: Fire, Flood, Weather, Power

•EHR Security Mechanisms

• Authentication

• Role-Based Access Control

• Data Verification

• Transport Level Security

• Encryption Mechanisms

• Data/Storage

• Audit/Log

• Anonymization

•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

Some Policy Directions:
Report of the Steering Committee on Health for 12th Plan
(Incorporating Reports of the Working Groups and deliberations of the Steering Committee Meetings)

National eHealth Authority(NeHA) of India

A major initiative to set up National eHealth Authority(NeHA) of India by MoH&FW  is underway with a  Vision to ensure adoption of e-Health and related standards in India in an orderly way and thus realize maximum benefits from use of ICT for all stake-holders in Healthcare domain

The concept document was  put up on MoH&FW website for wider discussion before finalisation

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