The document discusses issues with India's public health system and proposes implementing a health information exchange network called EMREMR. Key issues include doctors lacking proper medical knowledge, workers often absent, and patients bearing the burden of record keeping. EMREMR would streamline information sharing between patients, doctors, hospitals, insurance, and more. A pilot program in one district is suggested to test connecting primary health centers, hospitals, and diagnostic centers through a cloud-based system to improve care quality, access, and preventive healthcare. The lack of electronic medical records across India's fragmented healthcare system is problematic, as it would not be tolerated in other sectors like banking.

1. Suggestions to improve Health
Services to the common Man

2. Some observations on Primary Healthcare
In a 2005 study, World Bank reports that "a detailed survey of the knowledge of
medical practitioners for treating five common conditions in Delhi found that the
typical quality doctor in a public primary health center
– has a more than 50-50 chance of recommending a harmful
treatment".
Unannounced visits by government inspectors showed that
– 40% of public sector medical workers could not be found at the
workplace.
•This has lead to wide spread success of Rajiv
Aarogya Shree (access and choice)

3. Current Issues faced by patients
• Advice the patients where to go and what to do
• Waiting time, patients often wait in less than desirable places
like waiting halls for a day or two if not for a few hours
• The burden of organizing and maintaining relevant medical
records is on the patients(who are often poor and uneducated)
• Hospitals both private and public operate independently, the
makes referral system very informal and erratic and often
unplanned
• Patient or the referring is often unable to make the best choice
of specialist convenient for all due to absence of any
information network.
• Recording a sequence of events, for future diagnosis and
reference especially for chronic care
Solution is Health Information Exchange

4. Health Information Exchange

5. EMREMR

6. Global experiences
US:
Prescription error, Low EMR information interoperability,
Low EMR adoption.
Since 2004 there is federally mandated push for EMR adoption
Since 2009 greater emphasis on interoperability as well.
Canada:
Moderately high level of EMR adoption, GPs have seen about 22% increase in
throughput (Productivity tool)
Africa:
Mashavu - networked healthcare (closest to our rural need) using gps/internet and
computers
Denmark:
Vibrant Fully integrated Healthcare Information Exchange. About 20% savings in cost
post national network.

7. Silos of operation
All too often, government planners, business executives, and nonprofit
organizations have operated at cross-purpose.

8. Benefits of EMR to our people
• More efficient and transparent healthcare to downtrodden – A
fundamental need
• Reduction in travel by patients
• Early disease pattern detection
• Enabling preventive care
• Elimination of paperwork hassles by patients
• PHCs to be nodal point to be reinforced
• Targeted disease cure
• Avoid prescription errors
• Targeted specialist referrals
• Ease stress on specialist doctors
• Peer reviewed standard operating procedure
• Establish standard operating procedures for treatment
• Monitor Child health
• Allow pharmacy to better target patient need
• Reduce spurious drugs in the system
• Large scale micro customization
• Transition from transaction base care to health indicator monitoring
• Incentivize GPs to improve health rather than just treat disease (GP
incentive programme in UK)

9. Recent events
• Rajiv Aarogya Shree programme by Govt of AP
o led to investment by private sector in healthcare infrastructure
o AP in on the verge of becoming a leader in terms of modern
healthcare infrastructure
o But it does not address preventive healthcare
o this gives us a means to get all the providers of healthcare under
one pervasive network

10. Policy Makers
Drug Makers
Education

11. Current Patient Information Flow
Patient
Doctor
Health Department / Govt
Drug Stores
Drug Manufacturers
Health Insurance
Diagnostic Centers
Non-Coordinated
Information Flow

12. Target Patient Information Flow
EMREMRPatient
Doctor
Health Department / Govt
Drug Stores
Drug Manufacturers
Health Insurance
Diagnostic Centres
Streamlined
Information Flow

13. Aarogya Shree
• A boon for poor
• The current program is transaction based which is
effective to make high skill/cost treatment available to
the poor for free.
• The program should work backward and integrate itself
with preventive healthcare
• Primary Healthcare Centre (PHC) can transform itself to
include preventive healthcare in their delivery
• Establish peer reviewed standard operating procedures

14. Why preventive healthcare
• Make GPs more effective and relevant to patient
• Ease the burden on traditional transactional
healthcare system which is effective for
treatment
• Monitor patients with lifelong health issues like
hypertension, diabetes etc
• Address local ailments like fluorosis
• Preventive Care Saves Money -- not just for the
government but of the patients as well (higher
productivity)

15. How do we begin
• Pilot project
– 1 district covering 1 hospital, corresponding PHCs(Primary Health
Centre) and selected diagnostic centres
– Master Data creation for patients who report to the hospital and
PHCs
– Prototype application development to cover the scope of pilot project
– Connectivity between PHCs and hospitals with pilot head quarters
– Hardware – We suggest cloud to avoid hardware infrastructure
investment for the pilot
– Data Entry operators with thin clients(computers)

16. Summary
• "Can you imagine going to your bank and
having them write out your account, keeping
track of it by pen and paper, and then you go
to another bank and they don't have that
record? We wouldn't tolerate it, so why do
we tolerate it in a health-care system that
doesn't have the most basic thing, which is a
national electronic medical records system?“

17. References
• http://www.govtech.com/gt/374043