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Electronic Health Record Standardisation in India


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Title: Electronic Health Record Standardisation in India

Electronic Health Record Standardisation in India
  • Baljit Singh Bedi
  • Advisor, Health Informatics, Centre for Dev. for
    Advanced Computing (CDAC) Ministry of
    Communication IT(MCIT),Govt. of India
    Member, National EMR Standardisation Committee,
    MoHFW Chair, Sub-Group, Interoperability
  • Chair, FICCI IHIN Working Group on HER and
  • Past President, Telemedicine Society of
  • Ex. Sr. Director Head, Telemedicine
    Div., Dept. of IT, MCIT, Govt. of India )

International Conf.Transforming Healthcare with
IT(THIT),Bengaluru, 16-17 Oct 2015
  • Background Relevance of ICT in Health Sector in
  • Relevance of Standards for Healthcare Sector-
    Case for EHR Standardization
  • Ministry of Health Family Welfare Expert
    Committee for Standards
  • Notified EHR Standards by MoHFW
  • Important Policy Directions

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
The Need for Standards for Healthcare Sector
  • 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 Health Information Systems and
    eHealth/mHealth services within the country and
  • Electronic Health Record(EHR) is one of the most
    important parameter in this standardisation

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
  • (Audiographics),
  • The H.320 standards address ISDN
  • 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.

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
  • -The "Integrated Care EHR" as defined in ISO/DTR

EMR Standards Committee of MoHFW
  • Ministry of Health Family Welfare (MoHFW),
    Govt. of India constituted a Committee of
    Experts for Development of Standards on EMR in
    Sept 2010 under Chairmanship of Additional
    Secretary DG,CGHS, MoHFW
  • 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
  • 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 MoHFW Website
  • National Implementation Committee for roll out
    has been set up
  • Recently a Fourth Sub-Group has been set up to
    take into consideration the Legal and manadatory
    aspects of notified EHR Standards

Categories of Standards required for
eHealth/mHealth and other Healthcare Information
Codes Terminology
Content Formats
Security Access Control
  • Patient Id
  • Provider Id
  • Payer Id
  • Health Plan Id
  • Pharmacy Id
  • Disease Codes
  • Procedure Codes
  • Observation Codes
  • Drug Codes
  • Surgical Consumables
  • Patient Enrollment Registration
  • Patient Medical Records
  • Billing Formats
  • Minimum Data Sets
  • Lab Formats
  • Authentication
  • Access Control
  • Non Repudiation
  • Privacy Protection

Some Healthcare Informatics Organisations /
Standards considered
Organization Standards
National Recommendations for Health Information Infrastructure in India Information Technology Infrastructure for Health (ITIH) framework Recommendations on Guidelines, Standards Practices for Telemedicine in India Indian health information network development (iHIND) recommendations from the National Knowledge
International Organization for Standardization (ISO) Requirements for Electronic Health Record Architecture (ISO / TS 18308)
European Committee for Standardization (CEN) CEN / TC 251 EN 13606
Code of Federal Regulations (CFR) Health Information Technology Standards, Implementation Specifications, and Certification Criteria and Certification Programs for Health Information Technology (Title 45, Part 170)
Healthcare Informatics Organisations/ Standards
.. Contd.
Organization Standards
American Society for Testing Materials (ASTM) Continuity of Care Record (CCR)
Health Level 7 (HL7) HL7 v2.x HL7 v3 HL7 Clinical Document Architecture (CDA) EHR - System Functional Model
HL7 ASTM Collaboration Continuity of Care Document (CCD)
National Electrical Manufacturers Association (NEMA) Digital Imaging and Communications in Medicine (DICOM PS 3.0 2004 onwards)
Office of National Coordinator for Health Information Technology (ONCHIT) United States EHR Meaningful Use
Approved Standards Codes
  • Clinical Terminology (for clinical observations)
  • Laboratory Observations
  • Regenstrief Insts LOINC
  • Diseases (Diagnosis)
  • WHOs ICD 10
  • Procedures
  • ICD 10 PCS
  • Disability
  • WHOs ICF

Messaging, Imaging, Clinical Document Format
  • Messaging
  • HL7 V3.0 RIM (Reference Information Model)
  • HL7 V2.5 (for backward compatibility)
  • Imaging
  • NEMAs 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)

Recommended IT Standards Phase 2
DSM Psychiatric conditions Diagnostic statistical manual of mental disorders
NIC/NOC/NANDA Nursing interventions classification This is optional
CDT 2, US Dental Procedures This is optional
Unknown AYUSH clinical terminology, treatment planning including medication details Ayurveda, Yoga, Unani, Siddha, Homeopathy systems of medicine as distinct from the allopathic (Western) system of medicine
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

EHR-Preservation, Ownership Security Guidelines
Guidelines are present in the EHR Standards
of Health Family Welfare) NOTIFICATION
regarding Clinical Establishments (Registration
Regulations) Act 2010 (23 of 2010) New Delhi,
the 23rd May 2012
G.S.R.387 (E).-In the exercise of powers
conferred by Section 52 of the Clinical
Establishments (Registration Regulations) Act
2010 (23 of 2010),the Central Government makes
the following Rules, namely-
  • 9. Other conditions for registration and
    continuation of clinical establishments.- For
    registration and continuation every clinical
    establishment shall fulfill the following
    conditions, namely.-
  • .
  • (iv) Clinical establishments shall provide and
    maintain Electronic Medical Record or Electronic
    Health Records of every patients as may be
    determined and issued by the Central Government
    or State Government as the case may be from time
    to time.

National eHealth Authority(NeHA) of India Draft
National Health Policy 2015
  • A major initiative to set up National eHealth
    Authority(NeHA) of India by MoHFW is underway
    with a Vision to ensure adoption of e-Health and
    notified EHR standards in India in an orderly way
    and thus realize maximum benefits from use of ICT
    for all stake-holders in Healthcare domain. This
    is reflected in the Draft National Health Policy
  • Initial focus of NeHA would be on addressing
    implementation issues and promoting mechanisms in
    support of the same.The concept document was put
    up on MoHFW website for wider discussion before
  • MoHFW has become a member of IHTSDO in April 2014
    . with a view of widespread adoption of SNOMED-CT
    in India MoHFW has also nominated C-DAC as
    interim NRC.

General Recommendations
  • It must be added that these recommended standards
    cannot be considered either in isolation or as
    etched in stone for all eternity.
  • This document must be a living document
  • These will need to undergo periodic review and
    update as necessary
  • A high level Committee has already been set
    up in MoHFW under Chairmanship of Additional
    Secretary to review and suggest updation. Draft
    is already under advanced stage of finalisation

Thank you
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