India’s Unique Position, Why India? Why Now?

[Go to the main IndiMR Site]

Why is India in a unique position to undertake the development and deployment of a national level EMR? And, why at this moment in history?

For several reasons:

1. India has a large, exceptionally talented IT manpower, with an unmatched experience of handling large projects of diverse kinds.

2. India is at the point of radical departure from how government provides healthcare to a billion plus people. A NITI Aayog proposal describes a new plan, under which the public health provider infrastructure, which used to be built by the government and managed by doctors and personnel employed by it, is proposed to be moved to a public-private partnership model. Private doctors and private health facilities will now be the backbone of the national health service at the primary level. The government will reimburse the private healthcare entities based on the type and the volume of services rendered. Even at the secondary level, private hospitals of many different kinds will play a greater role in government health programs. With so many new entities, both medical professionals and private businesses, playing a role, the only way to make them part of a seamless service is by leveraging IT to provide a shared information infrastructure. By simply creating a new reimbursement model, without creating such an infrastructure will lead to a nightmare in the future. The availability of a free software system, along with its linkage with insurance reimbursement will also encourage doctors to diligently enter data into the system.

3. The field of health information systems in India has not yet been run over by several monopoly-like EMR companies. Such companies not only have little incentive to support standards but see their prosperity in thwarting them. Without standards, each system becomes an island and does not communicate or share information with others.

4. The national biometric ID project (UIDAI) or Aadhaar, provides an ideal solution to a problem faced by some other countries, which is the lack of continuity of care due to the records for the patients being fragmented across systems of different providers. In the US, for example, reconciling of records from different systems has always been a challenge since it is not always possible to definitively identify patients in different systems, to allow reconciling their records. Aadhaar will allow linking all disparate records of an individual into a seamless record. Availability of a system like Aadhaar serving as a backbone for the National EMR System is something that many nations would envy. Indeed, one can say that one of the most daunting and critical part for a nationwide EMR system is already available to us.

5. Immense body of knowledge is now available from many projects. There are many large sized open source projects, the lessons from which the National EMR project can draw upon. Even in healthcare there have been many projects which may offer valuable lessons to the national EMR project. Some open source projects in the past have floundered or failed because there was no sustained support for them from a company or government organizations. Given an assurance of viability, many developers will be keen to participate in such a project.

6. The technology of web-accessed cloud-based and blockchain-enabled systems has grown by leaps and bounds in the last 5 years while most current popular EMRs seem to be stuck with the technology of early last decade. An interaction with an EMR system in the from one of the established vendors in the West is like being transported back to the past, in a time machine. Once a large system becomes widely implemented and used, it is difficult to get rid of it for many reasons. The success and popularity of the VistA system and other systems derived from it, puts them in the same category. The Indian National EMR could be built from ground up using the newer, extensible and scalable technologies.

7. The government recently announced the National Health Protection Scheme, under which 10 crore Indian families (50 crore beneficiaries) below poverty line, will be provided health coverage, up to ₹5 lakhs annually, making it the world's largest health insurance program. To make this scheme a success, Aadhaar will play a key role, but availability of NEMRS will be just as critical. The NEMRS will not only ensure there is no fraud but will also reduce the administrative overhead, and make the disbursement of benefits quick and accurate. The NEMRS will also ensure that scheme becomes quickly available to most beneficiaries.

8. As part of the scheme, Ayushman Bharat, announced recently health and wellness centers will be opened across the country, signifying a shift in emphasis toward wellness rather than only on curative care. For effective wellness, a longitudinal medical record of the beneficiaries is a must. The NEMRS will be critical in providing such a record. The wellness centers can help in disseminating patient specific advice and instructions via SMS or emails, if their health records are available in an electronic format.