E-Objects Implementation

1. eObjects
Implementation

2. About ACCESS Health International
2
We have 8 Country offices across the
globe.
ACCESS Health International is
a think tank and advisory
group. We believe all people
have right to access high
quality, affordable healthcare
Healthcare
Delivery,
Performan
ce, Quality
Health
Finance,
Health
Policy,
Research
ACCESS
Health
Digital for
Universal
Health
Coverage Health
Insurance,
States,
Capacity
Building
Research
Advocacy
Advisory

3. About ACCESS Health Digital
3
DEPARTMENT
OF DIGITAL
HEALTH
SOCIAL ENTRE
PREURSHIP
ACCELERATO
R
DIGITAL
HEALTH
CENTRE OF
EXCELLENCE
Research
Advocacy
Advisory
ACCESS Health Digital works as a
strategist for all digital health initiatives of
Access Health in India.
The key focus is to support and build a
harmonized digital health ecosystem to
achieve Universal Health Coverage in India by
highlighting new ways for healthcare systems
to leverage technological advancements to
transform into digitally driven systems.

4. Access Health Digital-Helping Indian Healthcare leapfrog
Dr. Pankaj Gupta
Head – ACCESS Health Digital
digital.health@accessh.org

5. 6 PILLARS OF DIGITAL HEALTH
Setting
Interoperability
standards and
Health Data
Dictionary (HDD)
Building a
Strategy for
‘Healthcare
Delivery’
Information
Systems
(HDIS)
Designing a
‘Health Insurance
Information
Platform’
(HIIP)
for India
Moving toward
’Electronic Health
Record’ (EHR)and
‘Health
Information
Exchange’ (HIE)
Choosing a
GOVERN-ANCE
entity to oversee
the
‘Big Picture’
Facilitating the
creation of the
Health Information
Infrastructure
DIGITAL HEALTH
CAPACITY BUILDING
ACCESS Health [Prof Dennis Straveler and Dr Pankaj Gupta] first wrote the concept of 6 Pillars in NITI Aayog Theme papers,
Health System for a NEW India: Building Blocks, Delhi, India, 2019.

6. History: Where did it all start

7. Modi Govt puts
eHealth in
Manifesto
NIN, Facility
registry
Over the past few years, in addition to analyzing global best practices, conducting landscape assessments,
considerable consultations were conducted with relevant stakeholders at the center / state, academia, private sector.
Digital Health | India’s Policy Journey So Far..
2008 2011 2013
2017
2018
2019
Government
of India’s
National
Knowledge
Commission
Mission Mode
Project on Health,
National e-
Governance Plan and
‘Public Health IT
Study Report’ by
NHSRC
EHR and
MDDS draft
standards
India’s National
Health Policy
Release of
National Health
Stack (NHS) by
NITI Aayog
(Also, MoHFW initiated
process to setup NDHM
as a statutory body)
Launch of the NDHB by
Health Minister
(post incorporation of feedback
received from the public)
Based on IndEA Architecture of
Digital India
2015
Concept Note on National
eHealth Authority
Multiple consultations on Digital Health architecture by development partners along with Ministry
of Health and Family Welfare (MoHFW)
Ayushman Bharat
(PM Mission Mode
Project)
MDDS
Notification
7
National Rural
Health Mission and
Vertical Programs
write their own IT
Systems in Silos

8. eObjects Story

9. Book by NITI Aayog | Health Systems For New India: Building
Blocks
E-OBJECTS BASED ON FHIR RESOURCES FOR DATA POINT LEVEL
INTEROPERABILITY: PROVIDER TO PAYER AND PROVIDER TO PROVIDER
OPD
eObjects
E-Prescription
E-Referral
IPD
eObjects
E-Preauth
Request
E-Claim
E-Discharge
Summary
Provider
Payment
E-Provider
payment
E-Payment
Remittance
Advice
ACCESS Health [Prof Dennis Streveler and Dr Pankaj Gupta] first wrote the concept of eObjects in NITI Aayog Theme papers, Health System for a NEW India: Building Blocks, Delhi, India, 2019.
CHAPTER 5 - Reimagining India’s Digital Health
Landscape: “Wiring” the Indian Health Sector
*Released Nov 2019

10. What are e-objects
Address
To and From
Patient Demographics
Encounter Details
Diagnosis Details
Clinical Orders
NDHB and
MDDS
Compliant
E-object is like an
Envelope with machine
readable letter inside it
 Standard Format
 standard value sets
 machine-readable
 Interoperable
Header
Segments –
Standard and Custom
MDDS based metadata
Header will contain Unique
identification of all the
parties involved in the
transaction or episode
Segments will be specific
to the e-object type and
will group various
informative data elements
together. Eg: Facility
Details or Patient
Demographics etc
All the data elements and
code directories or value
sets used in e-objects will
be taken from MDDS
standard.
JSON
based
Object
FHIR R4 –
messaging
standard
What are e-objects?

11. Provider E-Objects
Header (Information about facility,
provider and beneficiary/patient
Clinical Brief(Active Allergies,
Active complaints, comorbidities,
Active Diagnosis),
Prescriptions (Ordered Rx, Labs
with result, Procedures)
Doctor’s Advice for
admission/follow up
• E-ENCOUNTER NOTE
• E-PRESCRIPTION
• E-REFERRAL
• E-DISCHARGE

12. eObjects exchange using FHIR 4

13. Provider Object Exchange using FHIR 4

14. How does the proposed EHR work?
Registry,
Health ID and
Consent from
user
PHR
(real-time data aggregation)
Hospital
Diagnost
ic lab
Clinic
Health
Data
Access
Fiduciaries
(HDAF)
Health Data stays with providers (or TSPs) and is
pulled together on demand with consent into a
longitudinal record
• Providers integrate with
HDAFs using std Open APIs
• Documents use embedded
schemas - Initially we expect
items already digitized and
currently given to patients
• Diagnostic reports, Discharge
summaries. Over time -
prescriptions, primary care
encounters will come in

15. Key Challenge | Inability to drive data backed Governance to
improve health outcomes centrally or at the state level
Block
Facility
MCTS –
Reprod.
& Child
Health
System at
National
Level
NACO
National
Disease
Program
Hospital
Informatio
n
Systems,
EMR
State
Health
Programs
e.g. EMRI,
eMamta,
HMIS,
DHIS
Directorates
Center Ministry
District Admin
State HQ
IDSP
National
Disease
Program
Malaria
National
Disease
Program
RNTCP
National
Disease
Program
Web portal
–
Reprod.
& Child
Health
System at
National
Level
Private
Sector
o Local Identifiers: Lack of Global Unique identifiers for person,
provider, facility and health workers
o Standards lacking:
o Architecture, I/O
o Data and interoperability standards
o Semantic mismatch of concepts: Lack common meaning of
data across systems
Inability to drive data
backed health resource
planning
Silo’ed set of health systems and applications
Reduce disease burden
and provide coverage
15

16. Overview of Registries| State Govts. – May either retain placeholders
in your applications or start using relevant local IDs
Registry
• Definition in simple words
• A digital Register which stores information of
an entity to identify it uniquely.
• The information/parameters stored in a registry
remains constant throughout and serve as
“Single source of Truth”.
Unique Identifier
Facility
Provider
Personal Health
Identifier (PHI)
Health
Worker
• As per NDHB, every healthcare
stakeholder/ entity will be identified
uniquely
• Govt. will develop and implement these
registries and every stakeholder should
connect to these for an integrated and
interoperable healthcare ecosystems
Minimum National Identifiers
Objective of UHC and continuity of care based on HIE model ,the focus of any national digital strategy has
been to setup unique healthcare identification services with below minimum national identifiers

17. Proposed Health Information Network
Facility1 Facility2 Facility3 Facility1 Facility2 Facility3
Block
1
Block 2
Nutrition
National
Reproductive
& Child
Health Portal
National
Disease
Programs
e.g. Malaria,
IDSP, NACO
Hospital
Information
Systems,
EMR
State Health
Programs
e.g. EMRI,
eMamta,
HMIS, DHIS
Birth,
Deaths
Private
Sector
HDD (Co-Directory
lookups)
Registry
Lookup
MDDS ~ concept
translation layer
Terminology
lookups
eObject
Modellers
FHIR
APIs
State Health Information Exchange
Data Lake
Disease
Registry
State
Registry
Indicator
Registry
Payment
Registry
Patient
Registry-UID
Service
Registry
Patient
Private and Govt. e.g.
NHPS, ESI, PM-JAY, JSY
Payers
Providers
Private
Sector
MOHFW
District
Admin
State
HQ
Reprod.& Child
Health
Directorates e.g.
Malaria, IDSP, NACO
Claim
portal
Block 1
Final Vision- National level Interoperability

18. Social Entrepreneurship Accelerator

19. SEA Community | Key Objectives
Minimal Viable
Product Definitions
(MVP), for various
care delivery settings
across primary,
secondary, tertiary
and health insurance
segments.
Mentorship, to provide
technical and functional
mentorship for
implementation of the
Minimal Viable
Products (MVPs) into
the partner products and help
build the micro services and
Application Programming Interface
(APIs) together with the product teams of
the (SEA) community.
Market Access, AHD, SEA
will act as a catalyst for
providing market access in
terms of positioning the
products for relevant request
for proposals (RFPs), Tenders,
new projects and business
partnerships.
Stamp of
Confidence, ACCESS Health
Digital (AHD), SEA will put its
stamp on the products that adopt
the MVPs.
SEA will strongly position the early
adopters in its network as
National Digital Health Blueprint
(NDHB) Standards
compliantproducts.
Access Health
Digital intends to
facilitate the
Social
Entrepreneurship
Accelerator (SEA)
community
through:
Partnership underway with the
NHA Market Access Program
(NHA Innovation Unit)

20. Primary Care- Public Health Delivery
Primary Care- Private Health Delivery
Secondary care-Hospital Information System/CRM /EMR
Cohort #1 | SEA Members
Data Analytics/Health Insurance
Diagnostic Solutions
Electronic Health Record Platform
Disease Mgmt.

23. 2
3
Add - on Modules
Registration
EMR
ADT
Billing
Outreach
LIS
RIS
Pharmacy
Modules for Health Delivery Information System (HDIS)
The grey blocks above are representation of functionality sets (also known as Modules) within HDIS universe. All these modules are required
functions that any healthcare ecosystem will need. There can be more modules but these are the minimum that must exist in healthcare sphere.
These modules caters not only the hospitals but also public health delivery centres like PHCs, SCs, HWCs, Dispensaries, Pharmacies of private etc.
But a PHC might not need full set of modules rather a subset of these modules.
Core Modules for MVP
Appointment
Telemedicine
CSSD
Emergency
Diet
Inventory
eObject
Surgery Mgmt.
Blood Bank
Nursing
Alert & Reminder
Primary, Secondary, Tertiary

24. Technology Aspects

25. Disruptive Innovations: Netflix and Amazon
25
Netflix's goal is clear: to become the go-to place for new releases
Three reasons Netflix is a leader when it comes to online streaming:
• Challenged the status quo e.g. began as a DVD-delivery service but now is
widely credited for putting video rental stores like Blockbuster Video out of
business and is eyeing to disrupt the film industry now
• Leveraged the right technology (e.g. microservice architecture) at the right time
• Content is king (e.g. Quarter 3 report last year, in 2019 Netflix spent about $15
billion dollars on content alone)
Netflix will certainly have competition with Disney, who owns the rights to seven of the top ten highest-grossing
films of 2019. But just as we wouldn't see so many automakers starting to build electric vehicles if it wasn't for
Tesla paving the way, we wouldn't see so many streaming services if it wasn't for what Netflix taught them
Source: https://www.inc.com/justin-bariso/netflix-killed-blockbuster-video-movie-theater-is-next.html
https://www.mobihealthnews.com/news/amazon-care-goes-live-its-seattle-based-employees
Amazon enters Healthcare! Amazon Care goes live for its Seattle-based
employees
Patients will be able to access care through multiple channels including texting,
video chat and a mobile care clinic, where a nurse will come to the patient’s home or
office. The service will also allow patients to get their medications deliver via a “Care
Courier” at their home or office.

26. Uber Example based on Microservice Architecture

27. What is Microservices Architecture?
Loosely
Coupled
Fine
Grained
Lightweig
ht
SOA
variant
Highly scalable,
resilient and
Configurable Design
Web/mobile/IOT Devices
Type
Format
Size
Registration
service
Visit Mgmt Service
Ordering Service
Rest API
(Req/Response)
API
Gateway
Microservice Architectural style is an approach
to developing a single application as a suite of
small services, each running in its own
process and communicating with lightweight
mechanisms, often an HTTP resource API.
Rest
API
Rest
API
Rest
API
Decomposition of
Business Concerns
based on DDD Principle

28. DATA ELEMENT XXX
DATA ELEMENT XXX
DATA ELEMENT XXX
DATA ELEMENT XXX
DATA ELEMENT XXX
MICROSERVICES
DATA ELEMENT XXX
DATA ELEMENT XXX
DATA ELEMENT XXX
DATA ELEMENT XXX
MICROSERVICES
MODULES
DATA ELEMENT XXX
DATA ELEMENT XXX
DATA ELEMENT XXX
DATA ELEMENT XXX
MODULES
HDIS MVP
DATA ELEMENTS >> MICROSERVICES >> HDIS MVP

29. Interoperability built into design through standardized master data
for the nation (MDDS)
DATA
ELEMENT
XXX
DATA TYPE,
DATA SIZE,
VALUE SETS,
CODE DIRECTORIES
META DATA AND DATA STANDARDS FOR HEALTH
1. Library of 1000+ Data Elements,
2. 140+ Code Directories
3. Registry Design
*Notified standard since Aug 2018
MDDS- Common Master Data set for India for semantic interoperability.
Common meaning conveyed by different code sets
Gender பாலினம்
HDD
System 1 System 2
ल िंग

30. 30
PAYERS –
PRIVATE AND PUBLIC
PROVIDERS
MARKET
SAND BOX
FOR
STANDARD e-
Claims
OBJECTS
PAYERS –
PRIVATE AND PUBLIC
PROVIDERS
SYSTEM
HDIS
BOLT-ON
SOLUTION FOR
STANDARDS
PAYERS –
PRIVATE AND PUBLIC
PROVIDERS
SYSTEM
HDIS WITH
STANDARDS BUILT-
IN
Sand Box will
produce the
specifications
and the test
environment
Bolt-On is the
best solution for
Existing HDIS
vendors
New HDIS Products
will build the
Standards in the
Information model
eCLAIMS AUTO
ADJUDICATION
eCLAIMS AUTO
ADJUDICATION
HDIS = Healthcare Delivery Information Systems
Potential Role of SEA Members

31. THANKS!
Dr Pankaj Gupta
Head – ACCESS Health Digital
digital.health@accessh.org
Twitter: @pankajguptadr, @accesshdigital
LinkedIn: drpankajgupta, accesshdigital