Patient data to become portable between govt hospitals, help health schemes

India’s health system could get another shot at reforms in the pre-election season. To complement the National Health Policy 2017, the ministry of electronics and information technology (MeitY) is expected to soon come out with measures to make patient care data available to doctors at government hospitals across India.

The move to IT-based systems will create a National Health Stack or scheme that will mimic health care facilities available for central government employees under the Central Government Health Scheme.

It is also expected to supplement the Centre’s Ayushman Bharat insurance project that was launched in September 2018. “Essentially, it would bring an order to the hospital system, where patient records are tossed all over,” said an official involved with the developments. The Centre will push for it even though some non-BJP-ruled states have opted out of Ayushman Bharat and launched their own schemes.

A pivotal element of the National Health Stack, as the MeitY sees it, will be to allow government hospitals in all states to share patient records and make available preventive and palliative care, long distance. These are not possible now as no centralised database exists for the doctors to use.

“It is not about making it easy for hospitals, the shared records will allow patient care to be provided at a preventive stage,” the official said.

About 200 government hospitals are at various stages of digitising their patient records and these would be available to each other once the scheme comes into existence.

The response to the e-connect project has been massive, said the official. More government hospitals have joined up than the system has the capacity to connect. “We have been fighting for such a system since 2002,” said Amir Khan, former advisor to Bill and Melinda Gates Foundation and a development economist.

He said the lack of portability of health records hits the poor the hardest, when they approach specialists at top government hospitals. “Those specialists can spend only a few minutes with patients, who often do not carry all their records or then have to undergo costly tests all over again,” he said.

The project is different from the MyHealthRecord project being developed by Centre for Health Informatics under the Ministry of Health and Family Welfare, with support from MeitY. The MyHealthRecord is a digital locker of patient records where access will be available only to the persons concerned. The Health Stack will instead build on the resources available in the records of government hospitals. The budget for the venture will be shared between the two ministries. The funding for the programme will have to be contoured between the states and the Centre, as most hospitals involved in the project are run by the former.

A missing element in the build-up of the records is the role of Aadhaar. Since there is no clarity on whether Aadhaar can be used to seed the data on patients, the hospitals and MeitY are working on alternatives to sew up the data. They agreed that it was difficult and could create fresh questions on whether such private data can be shared even among government agencies. Yet, telemedicine is not possible, especially at the preventive stage, unless patient data is made available. Health care can remain cheap only if preventive care capacity is built up big time,” the official argued.

Khan also said privacy had to be “sacrosanct” when providing health information system to doctors.

The Union cabinet under Prime Minister Narendra Modi had approved the National Health Policy, in March 2017. “The policy seeks to reach everyone in a comprehensive integrated way to move towards wellness (with) aims of achieving universal health coverage and delivering quality health care services to all at (an) affordable cost,” a government release issued after the meeting stated.

Under the policy, the government has tied up with the private sector to provide hospital care. The other element of the policy was to make available medicines and equipment at affordable rates. The third, which MeitY is spearheading now, is to bring patient care data on a platform that makes it easy for doctors to access from anywhere in India. It is expected to make public spending and provisioning of a public healthcare system comprehensive, integrated and accessible to all, officers involved said.