Insights into Editorial: A change called NeHA
The Government of India is now scheduled to launch the National e-Health Authority (NeHA). A regulatory body, tasked with overseeing the digitisation of health information, NeHA holds great promise.
Currently, the Indian healthcare system services a diverse population of approximately 1.24 billion across a wide range of geographic and socio-economic settings. The services are provided by a complex network of public and private care providers.
NeHA will be the nodal authority that will be responsible for development of an Integrated Health Information System (including Telemedicine and mHealth) in India, while collaborating with all the stakeholders, viz., healthcare providers, consumers, healthcare technology industries, and policymakers.
- It will be responsible for enforcing the laws and regulations relating to the privacy and security of the patients health information and records.
- National e-Health Authority (NeHA) aims to promote standardization of Electronic Health Records (EHRs) and facilitate its exchange across facilities in a secured manner.
- The proposed National e-Health Authority (NeHA) would not be responsible for centralization of the medical history of the patients.
The authority will have one chairman and four full-time members. The chairman will be an eminent person from the field of medicine or law and three members will be from diverse fields like medicine, public health, IT standards, health economics, management etc. A standing consultative committee would have representations from ministry of health, directorate general of health services, NASSCOM, IRDA, WHO, MCI and consumer rights activists among others.
NeHA would be responsible:
- To guide the adoption of e-Health solutions at various levels and areas in the country in a manner that meaningful aggregation of health and governance data and storage/exchange of electronic health records happens at various levels in a cost-effective manner.
- To facilitate integration of multiple health IT systems through health information exchanges.
- To oversee orderly evolution of state-wide and nationwide Electronic Health Record Store/Exchange System that ensures that security, confidentiality and privacy of patient data is maintained and continuity of care is ensured.
NeHA has been envisaged to support:
- Formulation of policies, strategies and implementation plan blueprint (National eHealth Policy / Strategy) for coordinated eHealth adoption in the country by all players; regulation and accelerated adoption of e-health in the country by public and private care providers and other players in the ecosystem.
- Establish a network of different institutions to promote eHealth and Tele-medicine/remote healthcare/virtual healthcare and such other measures.
- Formulation and management of all health informatics standards for India; Laying down data management, privacy & security policies, standards and guidelines in accordance with statutory provisions.
- To promote setting up of state health records repositories and health information exchanges (HIEs).
- To deal with privacy and confidentiality aspects of Electronic Health Records (EHR).
Need for NeHA:
One of the major challenges faced by patients in India today is that whenever he visits any healthcare provider he is typically subjected to a certain number of tests before the care provider initiates a treatment plan for his/her condition. If a visit is required to another healthcare provider for either the same or another care setting, the patient is likely to be put through the same process of examination, testing and treatment unless s/he diligently carries around his medical records.
With NeHA, a patient visiting another doctor wouldn’t need to undergo tests again or fill lengthy forms regarding their health information or addresses as the information will be readily available with the respective hospitals.
Benefits of NeHA:
- A centralised electronic health record repository of all citizens which is the ultimate goal of the authority will ensure that the health history and status of all patients would always be available to all health institutions.
- Such a move would mean the present practice of patients undergoing fresh tests every time they switch doctors would be discontinued and expenditure reduced. This would also expedite diagnosis and treatment.
- It would also be a repository of full health information that can be processed to generate epidemiological data on a massive scale.
- It will help avoid problems arising out of uncoordinated induction of IT systems in hospitals and public health systems.
- It will also enforce the laws and regulations relating to the privacy and security of patients’ health information and records.
- There would be a provision of Electronic Health Records (EHR) of patients. EHRs help doctors and hospitals to better manage care for patients by providing accurate, up-to-date and complete information, access patient records quickly for more efficient care and share electronic information securely with patients and other clinicians.
- The system will also reduce medical errors, promote legible and complete documentation, coding and billing and improve productivity.
The poor uptake of electronic records by doctors in India, the lack of inter-operability between systems and devices, and the legitimate concern for privacy, security and safety of medical data are all formidable barriers.
What needs to be done?
To get doctors to adopt electronic medical records (EMRs), any proposed systems must be easy to use and affordable. Careful attention must be paid to human-centered design and data minimisation.
- All too often, health information systems’ design and implementation strategies do not include end-users. Doctors are more likely to voluntarily adopt solutions that improve workflow, efficiency and access to information. This matter should be taken up while designing the software.
- The lack of inter-operability poses another challenge. The highly sequestered systems in US hospitals are not portable and result in duplication of tests and wanton waste. Risk-averse institutions and outdated laws have stymied digital innovation in healthcare. Millions are now being spent on retrofitting these systems to make them inter-operable, as required by the US Affordable Care Act. Such retrofitting can be bypassed in India.
- The easier the data flow between entities, the greater the potential for abuse. Therefore, inter-operability will need more than law and mandates. Substantial intellectual rigour must be devoted to building safeguards to protect the most vulnerable — the patients.
NeHA is a good beginning as many experts have often argued in favour of having some form of regulations and systems in place in areas like telemedicine, which very loosely is really doctor consulting over telephone or over the internet with the patient sitting miles away from the doctor.
- Yet, questions remain on how good an integrated health information system will be in a scenario where there is either lack of data or where there are huge gaps in data. And to top it all, the ability or the lack of it to manage data confidentiality and the standardisation so that it can be moved from one hospital to another.
- Therefore, unless the above mentioned challenges are addressed, NeHA may not succeed. Much now depends on what the government does to address these chalenges.
NeHA and regulatory laws that define India’s health information landscape will have deep, long-lasting ramifications on healthcare delivery. The necessary ingredients are all present: A digital health greenfield, robust telecom infrastructure, unique ID authentication, and a large talented pool of IT professionals. Utilising them may allow India to shape healthcare delivery globally.