India is in a unique position for launching a bold initiative. The time is opportune.
I propose that a public-private project to create a cloud-based National Electronic Medical Record system — The Great Indian EMR — should be launched. The EMR should be hosted on an infrastructure funded by government but maintained by private organizations and made available free of cost to all doctors and health provider organizations.
Why is India in a unique position? And, why is this a special moment in history?
For these reasons:
- In India the field 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.
- India has a large IT manpower.
- The national biometric ID project (UIDAI), currently underway, will allow providing longitudinal records of each citizen. Here in US, reconciling records from different systems has always been a challenge since it is not always possible to definitively identify patients in different systems. With India’s nationally unique ID this should not pose a problem.
- India can learn from dozens of past failed efforts (and a few successful ones) of creating large EMRs and apply those lessons to its own national EMR project.
- The technology of web-accessed cloud-based systems has grown leaps and bounds in the last 3–4 years but all current popular EMRs seem to be stuck with the technology of early last decade. Any interaction with an EMR here is like being transported back in time. Once a large system becomes widely implemented and used, it is difficult to get rid of it for many reasons (e.g., the imperial measurements in US even though the entire world except for Myanmar and Liberia, has moved to the Metric system, and even those two have plans for a changeover). The success and popularity of VistA system and other systems derived from it puts them in the same category. The Great Indian EMR could be built from the ground up using the newer, extensible and scalable technologies.
The EMR project should avoid the traps of large projects, such as trying to achieve grand goals by a centralized group of developers. Only the core and a framework should be developed. There should also be a set of standards stipulated for development of components and extensions. Developers should then be encouraged to create multiple small open source projects each creating a different component for the EMR, which are compliant with the standards to allow them to be used within the framework. Later, full EMRs could be created by picking the components that are appropriate for the needs of those creating them. Government should take the lead in funding such projects and give incentives to the private companies for contributing to their success.
Constraints and Requirements for the Great Indian EMR
The government should also facilitate creating groups of thought leaders and users to specify requirements specific to their needs and the needs of the country. It should create mechanisms for interaction between them and with the developers.
Some of the requirements and constraints for India (and other developing countries) are unique, for instance, lack of bandwidth and connectivity and lack of universal ability to use English, or poor literacy. However, many requirements are universal across nations belonging to different economic classes. An EMR of the current day has to be mHealth centric. A modern EMR that India would develop will not only have leapfrogged the enterprise LAN based EMR, it would also avoid a pure web-based approach, focusing more on the smaller devices.
An EMR with Benefits
Such a project will have several advantages for India.
It will take Indian healthcare up a notch by providing a reliable continuous health record for every patient leading to better care and reduced costs. Public health can start making changes immediately with the data directed interventions for the localities and neighborhoods that require attention. Health research will also get rich trove of data which may lead to significant discoveries.
It will be a boost to innovation in Indian technology sector, an area in which India seems to have slipped in the last decade. Private sector can start building specialized features/components or provide fully assembled EMRs customized for the needs of individual provider organizations. Examples of innovative features include using Big Data and Machine Learning technologies to predict outbreaks, detecting hot spots, and determining efficacy of traditional medicine remedies and unconventional approaches.
It is an uphill task to get organizations to agree to, and to follow standards once they have deployed an EMR of their own or from a private company. As US goes through a drawn out program of trying to coax everyone to follow interoperability standards, it is discovering just how difficult such an effort is. India can avoid such barriers if it quickly made available an already standards compliant EMR for everyone before several independent systems gain enough primacy in the field to be able to impede standards.
Finally, since it will be an open source project, it will considerably improve India’s image and soft clout internationally. The developing nations will be especially grateful for such gift. Such an EMR would be something that even a large developed nation like US will be inclined to adopt if done well.
Such a project would be considerably cheaper than many other national programs; certainly less expensive than the UIDAI project and the returns could be as great, in terms of money, well-being of the nation, addressing the needs of the people, and goodwill around the world.
Originally published at proteme.org on January 6, 2014.
