Parneeta Thakur has had a long day. She tries her best to be patient as the nurse on the phone takes her time to explain how a baby could weigh as high as 26 kilograms. The nurse is new to the system of electronic health records (EHR) at a primary healthcare centre in a village in Haryana. The nurse explains that she must have missed the decimal between 2 and 6.
The day has just begun at the State Health Resource Center (SHRC) in Panchkula, Haryana. Soon, 35-year-old Thakur, a domain expert at SHRC, would go through a binder as thick as a telephone directory and ask officers from the district hospital in Ambala if there really are “800 people admitted in a hospital with 200 beds”. “Is the average length of stay for a patient two years?”
Thakur is facing the typical teething issues that come with a government choosing to collect health records electronically. Haryana took the decision in 2013. It contracted American health giant UnitedHealth Group (UHG) which developed the E-Upchaar software solution in 2014. Today, district hospitals in areas such as Panchkula, Palwal and Hisar are collecting records from about 60% of their patients; most others record about 40%. Thakur is glad that the percentage is increasing from the measly 5% in 2016. The thick binders on her desk are piling up.
She is still not satisfied. “We have to push all the time to get the data. Ideally, data should be captured from 100% patients,” she says. Only then will she able to get the numbers that have the potential to completely transform healthcare delivery. It is only when certain figures—average cost per bed, occupancy ratio per bed, the average length of stay and out-of-pocket expenditure—that feature on every private hospital’s annual report are calculated that public healthcare could become efficient and transparent.
At least, that is what the Haryana government seems to want. And other state governments and the central government are waiting to see if Haryana can be successful as it quickens its pace on the hamster wheel. Last month, the health ministry gave an award to Haryana for the second highest number of quality assurance-accredited healthcare facilities in the country. Maharashtra has the highest, but since it is a much larger state, in terms of percentage of quality-assured healthcare, “we are leading”, says Thakur. The implementation of the EHR system in about 50 facilities, including primary, secondary and tertiary care, is one of the major factors that contribute to this achievement.
But it hasn’t been all smooth sailing.
