The opportunity

India has the opportunity to move forward using the HIMSS EMRAM 8-staged Maturity Model as a roadmap which comprises of 7 levels encompassing everything from Ancillaries to EMR.

The challenge

Yet, the Healthcare sector has been grappling with very slow adoption rates of an HMS / EMR. “Electronic health records were never a technology challenge but an adoption challenge, which only dissolves when clinicians realize the potential of EHR or when there is mandate either from a top management or from the government,” – Prashant Singh, Director and CIO at Max Healthcare. The Challenges in adoption were primarily on the financial considerations of high costs of procurement and maintenance.  Designing of the system without considering fundamental (e.g. number of clicks just to prescribe a sleeping pill) and well- known standards and medical codes such as:

• • • Health Level Seven (HL7)
    • Digital Imaging and Communications in Medicine (DICOM)
    • Continuity of Care Record (CCR) & Continuity of Care Document (CCD)
    • International Classification of Diseases (ICD) of the World Health Organization
    • Systematized Nomenclature of Medicine – Clinical Terms (SNOMED-CT) published by SNOMED International
    • Logical Observation Identifiers, Names and Codes (LOINC)
    • Inflexibility of the software; IT Support
    • Poor electricity supply and internet connectivity
    • Limited digital / computer skills of primary user’s
    • Lack of regulations for privacy protection.

Research-based Evidences

International Finance Corporation (IFC) panel discussion (Sep’20) called out key aspects of EMR in emerging markets.

• • • Do not let technology be your master. Manage the technology well to achieve what you want. One size does not fit all – EMRs in the USA will be different from India and South America.

• • • In emerging markets like Nigeria and others, less than 10% of the hospitals have implemented EMRs. Paper is the biggest competition. Low internet penetration, poor computer literacy and costs are other major impediments for large scale adoption.

• • • Flexible pricing models for different facility sizes, pay as you go models will be required to be provided by EMR organizations. This would make it more economical for hospitals to adopt these systems.

• • • Not every facility will require an enterprise level EMR. A modular based system should be offered by EMR organizations. However, do not build systems in silos. This will undermine the potential use of data and efficiencies

• • • Handholding, educating and training of hospital staff and doctors will be key for successful implementation and adoption of this system on a larger scale Regarding interoperability, the health system is currently not designed to, nor is willing to share patient information. Reporting formats, data collection, integration of platforms and other works will need to be standardized.

• • • HL7 FHIR (Fast Healthcare Interoperability Resources) based systems will see accelerated growth and drive interoperability. FHIR will be a game changer. Technology will make it possible, but people will make it happen. Hence, it is important to take people along for technology adoption.

Ensuring affordability of EMRs in emerging market will be important. Flexible pricing structure for different facility sizes needs to be designed and offered. Cross subsidization across large systems and smaller facilities is another option. This could also be achieved through local government initiatives and funding. Think global, act local for EMRs. Use international libraries like ICD 10 and others. Data should be transmittable for research and development. Standards should be global. Hospitals should be a combination of both digital/paperless and paper based for now. Some services can be completely paperless, but in some, it must be a combination. Hospitals should try to be paperless as much as possible and have a timeline for eventually going fully paperless. In India’s context, the adoption of EMR has been drastically low. This is due to a) several gaps in the system, b) lack of awareness & computer literacy, c) perceived high cost of implementation, d) lack of technological resources, e) complicated EMR interfaces and f) legacy issues to adopt new systems. The usage of EMR is limited to the big corporate hospitals in the metro cities and some select states and districts in India These challenges must be tackled head on, especially with initiatives like Ayushman Bharat presenting a valuable opportunity for building a person-centered health system. When this system is fully implemented, Ayushman Bharat will be the world’s largest healthcare program that’s digitally driven.

Leveraging the Healthcare technology  opportunity

With all said, multiple drivers indicate that Healthcare sectors will be the one to create value and impact.

Source: SMERGERS Industry Watch–Indian Hospital Sector

Health IT providers can help their clients address questions by being a bit more in tune with the innovation that is available to them and adopt that in a nimble, agile manner. You don’t have to deploy everything at once, but if you have a vision and implement in succinct stages, I think that will help the market get to where they need to go. It’s not about regulatory clicks; it’s about care delivery anywhere and technology addressing the cloud, mobility and Internet of Things that will allow patients to achieve wellness through participating in their own health management – moving them along an awareness to wellness continuum.