“As if it is not hard enough. We started with a cadaver on the first day of medical college and got out with an advanced speciality degree. We cannot be expected to learn computers too.”
What seems like a popular joke elicits a hearty chuckle from a room full of doctors. They are in a symposium on health informatics in Delhi in mid-January, where Tata Consultancy Services (TCS) is trying to bridge the chasm that has always existed among physicians, information technology providers and the health ministry officials.
In a series of presentations that follow, the doctors are told that they may not like it but they cannot escape technology for too long. The government is serious about getting the Electronic Health Records (EHRs) of the entire population and have them hosted on a new platform. And this time, the doctors have nowhere to hide.
Consider this: While the doctor sees a patient, she can also view her medical history, allergy warnings and medical reports on the computer screen. The patient can be anywhere in the country, and the doctor can prescribe the most effective treatment with immediacy and transparency.
As utopian as it may sound, that’s the least an electronic health system in a ‘Digital India’ must offer. The UPA government made a start seven years ago, and now the NDA government intends to build on it. By not only creating a database of epidemiological data for each patient but also making the sharing of information between hospitals possible via an Integrated Health Information Platform (IHIP). On 30 December 2016, the health ministry notified EHR Standards 2016. The standards are voluntary for now—a hospital, clinic or nursing home can choose to adhere to the standards that link them to the IHIP.
Even then, doctors and hospitals are not enthusiastic about it. In private, they cite two main reasons. One, getting used to an electronic system and recording epidemiological data is an unfamiliar process, which appears cumbersome; two, and more importantly, EHRs will make profit-motivated malpractices in the corporate healthcare sector open for scrutiny. In public, they are all for the new EHR standards.
The government knows that EHR standards are the first phase of a perfect storm. When it is over, it will push Indian healthcare towards transparency but until it blows over, policy makers will have to push themselves through the backdoor.
A service full of suspicion
Physicians and hospitals do not want the state to get in their hair. They had made it clear when the Clinical Establishments (Registration and Regulation) Act, 2010 had required the registration and regulation of all clinical establishments to adhere to a minimum standard of facilities and services. The law met with a protest from the Indian Medical Association (IMA).