India’s 1.3 billion people seek healthcare through a maze of public and private providers – the majority of these interactions are captured on hand-written paper records, or not at all. In January 2018, the Government of India announced what is potentially the world’s largest health insurance scheme, offering coverage for up to ₹500,000 (USD 7600) to approximately 500 million people. The need to monitor and evaluate services and payments for this vast insurance scheme will provide the impetus needed to jumpstart the health ecosystem. This greenfield also allows India to envision a bold new architecture for digital health data that avoids the shackles of redundancy and inaccessibility faced by health information exchange in the United States.
Our team of scientists from India and Harvard are developing scalable prototypes for health data exchange that will build on the core principles outline in our ROADMAP, published here: http://www.jmir.org/2018/7/e10725/; and on the Blue Book released by the NITI Aayog, available here:
A Federated Architecture underpinned by Personal Health Records
Prioritization of Patient and Population Needs over billing and compliance
Substitutability, that allows for a play-and-plug model of highly customizable applications that can address varying context-specific needs, and that respond to market incentives for better user-interfaces
Data-minimization that allows the creation of a "EHR-lite"
Technological solutions to ensure adherence to data and privacy regulations in India. Such Privacy by Design will be further supported by automated, consented and audited data flows.
Our partnership includes key research and healthcare institutions across the entire delivery system, including the St. John’s Research Institute (Bangalore), Seth G.S. Medical College & KEM Hospital (Mumbai), Government of India NCD Program and Dell EMC (Karnataka), iSPIRT, and primary care centers in both rural and urban India, committed to training, capacity building, prototyping and developing a federated API-enabled exchange ecosystem. The proposed model will avoid expensive proprietary health information silos and monolithic homogenous EMRs with centralized repositories, both of which are riddled with concerns for security, timely data transfer, usability, and high physician burnout
THE FIRST 12 MONTHS
For the proposed API-enabled, UPI-like technological spine to meet its game-changing potential, we foresee the following steps to scale, in the next 12 months:
Prototype an EHR-lite that is tested at a range of institutions
Prototype a Personal Health Record that exchanges data across multiple entities, including the NCD Screening and Management Tool, and the National Health Stack
City-wide PHR demonstration in a major Indian city (2019 first quarter)
Training, Development, and Testing across healthcare entities, chiefly, clinics, hospitals, laboratories, chemists (pharmacies), and public health agencies