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Inviting public comments on the draft of EHR Standards from MoHFW

ELECTRONIC HEALTH RECORD (EHR) STANDARDS FOR INDIA: Revised recommendations (over original August 2013 recommendations)

The revised EHR Standards for India which has been notified in February, 2016 have been placed in public domain with a view to elicit comments/views of the stakeholders including the general public. The comments/views may be forwarded to Director (e-Governance Division), Ministry of Health and Family Welfare, Room No 307-D, Nirman Bhawan, New Delhi-11010B or emailed at jitendra.arora@gov.in on or before 20 April, 2016. Click the Link

Executive Summary

The set of standards provided herein represents the recommendations of the Expert Committee arrived at after deliberating on the various aspects of standardizations in healthcare record systems

The set of standards provided herein represents the recommendations of the Expert Committee arrived at after deliberating on the various aspects of standardizations in healthcare record systems

In September 2013 the Ministry of Health & Family Welfare (MoH&FW) notified the Electronic Health Record (EHR) Standards for India. The set of standards given therein were chosen from the best available and used standards applicable to Electronic Health Records from around the world keeping in view their suitability and applicability in India. The Committee constituted to recommend the standards drew from experts, practitioners, government officials, technologists, and industry.

The notified standards were not only supported by professional bodies, regulatory bodies, stakeholders, but various technical and social commentators as well as being a step in the right direction. MoH&FW moved ahead with facilitating the adoption, as next steps, and in last two years the Ministry has made available standards like SNOMED CT free for use in country as well as appoint interim National Release Center (NRC) to handle this clinical terminology standard that is fast gaining widespread acceptance amongst the various healthcare IT stakeholder communities worldwide. At the time of notifying the standards in September 2013, it was understood that the standards themselves will continue to evolve over time.

Consequently, it was accepted that this notification will require revision from time to time. This becomes all the more necessary as understanding of those standards, their implementation and the expectations from the healthcare systems improve. Hence, MoH&FW constituted an expert group to review the earlier notified set of standards based on the experience and eyes firmly on the future.

The set of standards provided herein represents the recommendations of the Expert Committee arrived at after deliberating on the various aspects of standardizations in healthcare record systems. The Committee also carefully examined the provisions of open standards and the guidelines as per the norms suggested by DeitY, MCIT, Government of India and recommended the standards given later in the document. NEED FOR ELECTRONIC HEALTH RECORD For a health record of an individual to be clinically meaningful it needs to be from conception or birth, at the very least. As one progresses through one’s life, every record of every clinical encounter represents a health-related event in one’s life.

Each of these records may be insignificant or significant depending on the current problems that the person is suffering from. Thus, it becomes imperative that these records be available, arranged, and be clinically relevant to provide a summary of the various clinical events in the life of a person. An Electronic Health Record (EHR) is a collection of various medical records that get generated during any clinical encounter or events. With rise of self-care and homecare devices and systems, meaningful healthcare data get generated 24×7 and also have long-term clinical relevance.

The purpose of collecting medical records, as much as possible, are manifold – better and evidence based care, increasingly accurate and faster diagnosis that translates into better treatment at lower costs of care, avoid repeating unnecessary investigations, robust analytics including predictive analytics to support personalized care, improved health policy decisions based on better understanding of the underlying issues, etc., all translating into improved personal and public health. Without standards, a lifelong medical record is simply not possible, as different records from different sources spread across ~80+ years potentially needs to be brought meaningfully together. To achieve this, a set of pre-defined standards for information capture, storage, retrieval, exchange, and analytics that includes images, clinical codes and data is imperative.


This document provides a structured overview of the key EHR standards with respect to Indian healthcare system. For every aspect of data/information that is part of any healthcare record system has been addressed with a short guideline regarding implementation included. Various non-related recommendations from previous edition have been removed to better streamline the set of standards selected and achieve harmony among them.

A detailed recommendation on the interoperability and standards, clinical informatics standards, data ownership, privacy and security aspects, and the various coding systems are given. The set of standards given in earlier edition has been updated with their latest versions as we move towards a better implementation. LOOKING AHEAD This document is a continuation of its earlier version, but in many ways reflects our growing confidence in path correctly chosen earlier – set of international and proven standards focused towards syntactic and semantic interoperability.

The idea that any person in India can go to any health service provider/practitioner, any diagnostic center or any pharmacy and yet be able to access and have fully integrated and always available health records in an electronic format is not only empowering but also vision for efficient 21st century healthcare delivery. In conclusion, it must be reiterated that these standards cannot be considered either in isolation or as “etched in stone for all eternity”. These will need to undergo periodic review and update as necessary. Hence, this document must be a “living document”.