Electronic Health Records: Adoption and Overcoming Challenges for India

Considering the massive amount of medical and healthcare records being generated across multiple institutions, the EHR plays an integral role in connecting all of them to provide real-time data of patients at a common platform.

Electronic Health Records (EHR) is the digitized collection of patients' or populations' medical or health information. The vital health records of people are entered electronically by the healthcare providers throughout his/her lifetime. EHRs aim towards making patient-centered records securely and instantly available to authorized users on demand. EHRs form an immensely vital part of health IT as it encompasses all advanced treatment histories of patients:

• Contains patient's medical diagnoses, history, radiology images, allergies, medications, lab test reports, and immunization dates
• Allow real-time access to evidence-based tools allowing providers to make decisions about a patient's health
• Automate and streamline the provider workflow

EHR for India

The Government of India aims to introduce a uniform maintenance system of Electronic Medical Records / Electronic Health Records (EMR / EHR) by the healthcare providers and hospitals across the nation. The Ministry of Health & Family Welfare first initiated the standards for Electronic Health Record (EHR) for India back in September 2013. These pointers were on the basis of the recommendations made by the EMR Standards Committee constituted under the MoH&FW.

The draft of the EHR/ EMR Standards was hosted on the website of the Ministry initially, soliciting comments from the general public and stakeholders before implementation. After considering all the recommendations, the ‘EHR’ was finally passed by the Ministry of Health and Family Welfare.

Goals of EHR Standards

With the rise of medical homecare devices and systems, meaningful healthcare data gets generated 24x7, which has long-term clinical relevance. This is where Electronic Health Records come to the rescue as they collect all medical records generated during any clinical encounter or events.

• Promote interoperability and be specific about certain vocabulary standards and content exchange to establish a path forward towards semantic interoperability
• Promote all possible scope of technical innovation using adopted standards
• Support the evolution and real-time maintenance of the adopted standards
• Encourage adoption and participation by all stakeholders and vendors
• Keep implementation costs at a minimum
• Consider experiences, policies, best practices, and frameworks
• To the extent possible, adopting standards that are modular and not interdependent

Benefits of EHR

The benefits of EHR can be defined as follows:

• Managing EHRs requires comparatively fewer staff members, limiting the need for large spaces for record-keeping. Therefore, it costs much less to maintain and manage records with this approach.
• As the number of patients multiplies, the preservation of records becomes an even more significant challenge. EHRs, on the other hand, do not require to be printed on paper, hence no need to be backed by sizable physical storage spaces.
• EHR improves work efficiency and helps healthcare providers to reach their goals
• Provides quick access to critical patient records for efficient and coordinated patient care
• Offers a favorable environment for healthcare providers to enhance their productivity & work-life balance
• Reduces diagnostic and medical errors to improve overall patient care
• Improves interaction between providers and patients under a stable and secure environment, improving convenience
• Makes medical prescriptions even safer and reliable
• EHRs ensure easy accessibility of patient records from anywhere and at any time, and the data can be stored for an indefinite time
• Being in electronic format, it minimizes the number of records lost
• EHRs help track patient clinical progress and also improve patient compliance
• Provides a summarized report of the various clinical encounters in people’s lifetime, avoiding unnecessary repeating tests
• EHRs are completely easy to update for real-time availability of data to multiple users at a single point of time
• EHRs facilitate advanced health care decisions, providing evidence-based care all the time
• EHRs are used for research purposes as well

Steps to a Successful Implementation of EHR

Implementing an electronic health record is not an easy process, as it can get very challenging if not carefully undertaken using a step-by-step approach. This step-by-step approach is guided by six significant steps:

1. Assess the Organization's Readiness: The preliminary step towards EHR implementation is to assess the organization's current needs, goals, along with its financial and technical readiness towards the change. Only after having an accurate view of the preparedness can organizations design an EHR implementation plan that matches the specific organizational needs.
2. Plan the Adoption Approach: In the planning phase, organizations need to draw on the information gathered during the assessment stage to outline their EHR implementation plan. It is essential to measure and view each minute aspect of the plan from an electronic point-of-view.
3. Upgrade to or Select a Certified EHR: Organizations should upgrade to or select a certified and trusted EHR. The EHR implementation team should leverage the information gathered in the planning and assessment phases to choose the perfect EHR matching the organization’s needs and challenges.
4. Conduct Training for Effective Implementation of an EHR System: During this phase, organizations need to focus on training to ensure successful migration to electronic data maintenance. They will also need to prepare for EHR implementation go-live, including training, pre-go-live dress rehearsals, and elaborate pilot testing.
5. Achieve Meaningful Use: Organizations should work towards achieving meaningful use, focusing on the shift towards the Merit-based Incentive Payment System. The introduction of MACRA (the Medicare Access and CHIP Reauthorization Act) brought in the Medicare EHR Incentive Program, which transitioned into the Merit-Based Incentive Payment System (MIPS), harmonizing existing CMS quality programs.
6. Continue Quality Improvement: Once enterprises have implemented an EHR and achieved its desired meaningful use, they should focus on continuous evaluation and improvement. It is critical to revisit the organization’s goals and needs to refine workflows and improve patient outcomes continuously.

Security Challenges in EHRs

Compared to paper medical records, threats to electronic health records security will be a hurdle to the efficient sharing of medical records within organizations. But, to optimize its benefits, organizations need to consider and overcome major issues in electronic health records:

• Data Interoperability: The use of EHRs has multiple benefits to healthcare organizations, but these advantages are linked to data interoperability. When medical records are retrieved or saved, various aspects of the records are involved. The lack of interoperability solutions and standards has been a significant obstacle in the exchange of healthcare data between multiple stakeholders.
• Security: Organizations need to balance information risks and controls. EHR systems may have multiple security vulnerabilities, and one of the biggest threats is malicious code. Ensuring software and hardware vulnerabilities are addressed is crucial to protect the system and maintain business continuity.
• Business Continuity: Business continuity planning (BCP) is essential for maintaining continuous operations before, during, and after disaster events. Network failures, hardware failures, data loss, and attacks are examples of disruptions that EHR systems must handle with effective BCP in place.
• Digital Divide: The digital divide defines the gap between those with access to and know-how of technologies and those without. This issue leaves many patients behind, especially in developing countries, where EHRs are often not available. Lack of skill, infrastructure, and knowledge exacerbates this problem.

Challenges Faced by India for Implementation of EHR

The development and implementation of EHRs involve numerous challenges, especially in the Indian healthcare industry. Key challenges include:

• Cost: EHR implementation is expensive, covering hardware, software, implementation assistance, staff training, ongoing network fees, and maintenance. Smaller establishments may struggle to find financial resources for EHR implementation.
• Data Privacy: Data privacy concerns are significant due to the risk of data leakage from cyber attacks or natural disasters. Security breaches can lead to legal and financial repercussions.
• Data Migration: Migrating from paper-based to digital records is time-consuming and labor-intensive, especially without a defined format of data management.
• Training: Proper training is required for staff to adapt to the new system. The time and effort required for training can cause business disruptions, particularly for small and mid-sized organizations.
• Time: The process of digitization is lengthy, involving both training and data input, which can be challenging.
• Infrastructure: Many small healthcare providers lack the technical support and hardware needed for EHR systems, which delays implementation.
• Incomplete Coverage of Aadhar: The lack of complete Aadhar coverage has created gaps in the implementation of EHRs, exacerbating data security issues.
• Suitable Vendors: Finding reliable vendors for EHR setup, migration, and training remains a challenge for many organizations.