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Year : 2021  |  Volume : 2  |  Issue : 3  |  Page : 278-279

Electronic health records in India: Challenges and promises

Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India

Date of Submission10-Oct-2021
Date of Decision26-Oct-2021
Date of Acceptance06-Nov-2021
Date of Web Publication08-Dec-2021

Correspondence Address:
Dr. Nisha B Jain
Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JME.JME_94_21

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How to cite this article:
Jain NB, Nundy S. Electronic health records in India: Challenges and promises. J Med Evid 2021;2:278-9

How to cite this URL:
Jain NB, Nundy S. Electronic health records in India: Challenges and promises. J Med Evid [serial online] 2021 [cited 2022 Aug 10];2:278-9. Available from: http://www.journaljme.org/text.asp?2021/2/3/278/333992

  Article Information Top

Pai MMM, Ganiga R, Pai RM, Sinha RK. Standard electronic health record (EHR) framework for Indian healthcare system. Health Serv Outcomes Res Method 2021;21(3):339-362. (Doi: 10.1007/s10742-020-00238-0).

  Background Top

India has an ever-growing need for quality health care owing to its large population. India follows a quasi-federal structure of governance where health is on the concurrent list of the Indian constitution. The health-care system in India is at the cusp of its transformation and major credit for this paradigm shift goes to a digitalization of health care.

The electronic medical record (EMR) is a digital version of a paper record related to a patient's medical history documented inside the hospital and is not designed to be shared outside an individual clinical practice. On the other hand, an electronic health record (EHR) is a comprehensive report of an individual's overall health. The EHR is a collection of various different medical records and this digital record of a patient which can be accessed anytime anywhere. However, these two terms are often being used interchangeably. The EHR forms the core of India's goals of digitalizing the health care system.[1],[2]

In India, EHR adoption gained popularity in the last decade. The 2019 coronavirus disease (COVID-19) pandemic has further highlighted the importance of the need for a robust EHR system in place. The COVID Vaccine Intelligent Network (CoWIN) is an open-source, centralized digital service provider which tracks records of India's vaccination drive against COVID-19.[3] CoWIN is a good example of how digital technology is integral to our fight against COVID-19.

This article authored by Pai et al. (from the Department of Information and Communication Technology, Manipal Institute of Technology, Karnataka, India) published in Health Services and Outcomes Research Methodology in their latest issue has conceptualized the implementation of EHRs in the Indian public sector.

It highlights the status of the health information system in India's three-tier health care setup. The primary, secondary and most tertiary health-care centres have paper-based documentation. Not only human but monetary and infrastructure resources also get used up in storing and maintaining these paper-based records with the risk of being misplaced during patient referral being a major setback. Currently, a few tertiary care facilities in India have started to maintain EMR, but the information is retained by the primary hospital and is not transferable or accessible when the patient is referred for specialized care elsewhere making interoperability difficult.

The authors suggest a framework for collecting, processing and storing the data for EHR with ease both in rural and urban India with emphasis on cloud computing the data for easy accessibility. The authors bring out a solution to the problem of interoperability of software in India. Health records can be made interoperable by standardization of the terminology and group sharing.

They have researched into various models adopted for maintaining EHR worldwide and proposed cloud-based standardized EHR model for public health-care facilities which is secure and provides a solution to access patient health information from various levels of the health-care system in India. The proposed model uses the Aadhaar Card to serve as an ID to retrieve health records. This model assists in the reviewing of a longitudinal record, consisting of all health data, laboratory reports, treatment details, discharge summaries across one or multiple health facilities.

The authors have not only proposed the EHR model but also have validated it with real patient data of 60 patients from PHCs and 40 patients from CHCs. The test results have been error-free in capturing and sharing of patient data at various levels of our health-care system making it feasible despite the odds we face both in rural and urban India.

  Commentary Top

We believe that the EHR is the new future of the Indian health care system. The authors in this article have recommended a framework for collecting, maintaining and processing the information in a standardized format. They have suggested that the EHR model should be linked ID like the Aadhar card for every citizen so that personal medical and health records are linked and stored associated with a unique number.

However, the drawback of the study is that the authors have made a framework for linking health care at government-run primary, secondary and tertiary centres. The majority of the population still seek treatment at the nearby clinics and private nursing homes; probably because the primary health centres in rural areas are not open round the clock and for emergencies, they get referred to higher centres due to lack of availability of expertise and specialty infrastructure. The core of documentation at clinics and private nursing homes are paper-based case sheets as maintaining digital health records at these setups would add to financial burden and are thus, not attractive. The only way forward to digitalizing the document and records at the private setup needs incentives from the government for setting up the software and infrastructure.

The article describes the intricate details of an integrated EHR system starting from online registration details, admission, laboratory investigation, radiological reports, prescriptions to discharge summary. More importantly, it has emphasized the usage of terminologies and a standard coding system like the International Classification of Diseases making it easily transferable to another hospital at referral. In reality, the crux of its successful implementation at PHCs and CHCs will demand not only high-speed internet connectivity but more manpower. There is a need for PHCs and CHCs to be well equipped and well-staffed with designated personnel for data maintenance, as medical staff would not be well versed with technology at rural centres. We suggest that these persons be well trained; first, to understand various modules of the system and its operability and then get integrated with this system.

We propose the appointment of ad hoc trainees to aid in maintaining digital health. This would not only contribute to economic growth through job creation but also enable efficient work by medical personnel without compromising the care of the patient. A regular audit of the documents and cross-verification is much needed when aided staff are involved in maintaining data.

EHR systems across the globe are maintained through the effective use of a unique identifier. The authors have suggested the usage of Aadhar ID. India does not have a comprehensive or sector-specific (for health care) data security act. Aadhar is not backed by a strong security system making patient information vulnerable to getting hacked. Recently, the government has tried using Aadhar for ensuring COVID-19-related vaccination but there were issues related to its users without compromising on data security. The Aarogya Setu or the Indian COVID-19 contact tracing, syndromic mapping and self-assessment mobile application, which was implemented by the government in 2020 came under criticism on grounds of data security and could not be made mandatory.[4]

Recently, the Government of India has launched the Ayushman Bharat Digital Mission to support the integrated digital health infrastructure of the country. This aims to create a seamless online platform 'through the provision of a wide range of data, information and infrastructure services, duly leveraging open, interoperable, standards-based digital systems' while ensuring the security, confidentiality and privacy of health-related personal information.[5] We hope this achieves what it sets out to do but we also think there will be difficulties ahead related mainly to accurate and comprehensive implementation and issues of privacy.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Evans RS. Electronic health records: Then, now, and in the future. Yearb Med Inform 2016;Suppl 1:S48-61.  Back to cited text no. 1
Ehealth. EHR – A Basic Tool to Bolster Digital Health Infra; 2020. Available from: https://ehealth.eletsonline.com/2020/11/ehr-a-basic-tool-to-bolster-digital-health-infra/. [Last accessed on 2020 Nov 20].  Back to cited text no. 2
Ang A. India Opens Vaccination Platform to the World. Healthcare IT News; 2021. p. 1. Available from: https://www.healthcareitnews.com/news/asia/india-opens-vaccination-platform-world. [Last accessed on 2021 Jul 16].  Back to cited text no. 3
Sinha S, Majumdar S, Mukherjee A. Implementing electronic health records in India – Status, issues & way forward. Biomed J Sci Tech Res 2021;33:90-4.  Back to cited text no. 4
ABDM; 2021. Available from: https://www.ndhm.gov.in/home. [Last accessed on 2021 Oct 10].  Back to cited text no. 5


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