You go to Hospital A for treatment. You get well. But after six months, the illness recurs. You go to a different hospital, B. Even though all your personal data and treatment information were digitally entered in the first hospital, you have to start all over again in the second hospital, except that during the course of the consultation, the doctor has a look at the file from Hospital A. Nevertheless, a fresh file is opened in Hospital B.
A familiar experience for many of us. The treatment approach at the two hospitals could be different or even based on different healthcare systems – Allopathy, Homeopathy, Ayurveda etc. – leading to diverse records stored in silos. For continuity of care, access to these diverse information sets is important.
Though the concept of Electronic Health Records (EHR) has been around for many years, they are confined to individual hospitals, defeating the purpose of digitisation. One of the reasons for this is the complexity of managing information -- a problem that HealtheLife, one of the startups in Bengaluru, has been able to resolve to a great extent.
“In this segment, there are standards for health information semantics, privacy consent and security that every app has to conform to. It’s a challenge for developers to understand each of them, and ensure that their apps are standards-compliant,” says Dileep V.S., founder of four-year-old HealtheLife incubated at IIITB (International Institute of Information Technology Bangalore).
“We take care of all those complexities related to standards-compliance, security and privacy of clinical data, and technology. Our platform, EHR.Network, takes the present EHR to the next level, by helping developers enormously. Our estimate is they should be able to build apps in less than 50% of the time and cost,” he says.
HealtheLife achieved a significant breakthrough recently with the Karnataka government's mental health management system, e-Manas, being built on the EHR.Network.
Dr. Rajani P., Deputy Director (mental health), says, “Karnataka is the first State in India to come out with such an e-portal, which we have developed in collaboration with the technology partner IIITB, and NIMHANS, in order to help in the proper implementation of the National Mental Healthcare Act 2017 which provides a number of rights to the patients.”
She says according to the law, all mental health establishments and healthcare professionals have to be registered with the Karnataka State Mental Health Authority. “We are going to start the registration of establishments and professionals, and we will start with the government institutions.”
One important aspect of e-Manas is continuity of care for the patient. “If a patient first comes to Bengaluru for treatment, he can go to a doctor in his hometown, say Bidar, where the doctor will be able to access the patient’s record, of course, with the consent of the patient,” says Dr. Rajani.
Dr. Girish N., professor of epidemiology, NIMHANS, says besides the two advantages of continuity of care without the patient having to travel, and the availability of even old records online, there is a third advantage: from the practitioner’s point of view of getting certain mandatory consents from authorities in almost realtime without having to move papers.
“With this new application, when a patient is admitted to any facility anywhere, the respective Mental Health Review Board of the district will automatically get an intimation seeking permission. Without too much delay or effort, the MHRB will be able to take action, and the practitioner also able to take the required measures,” he says.
Though e-Manas is for mental health, the system has been built in such a way that in future it can easily be adapted for other areas like, for example, malnutrition.
Boost for startups
T.K. Srikanth, professor, E-Health Research Center, IIITB, says a big challenge for startups in the healthcare sector is that it is so fragmented that it is difficult to come up with a standardised product, with different apps for doctors, hospitals, etc. He says HealtheLife has built the EHR.Network, one of its kind the country, in such a way that disparate applications can be built on it, allowing for data to be shared in a consistent way.
“Interoperability requires two things: one, an agreement on how the servers talk to each other; and two, the manner in which data is stored so that they can be correctly interpreted by the other side. For that, you need some standard-based mechanism for storing data. That is where HealtheLife's contribution comes in,” says Srikanth. "They have built a system around an open, standards-compliant EHR that is interoperable with different systems."
In the first two years, HealtheLife worked on the first version of the EHR.Network which they launched in 2018. “But we didn't open it to the public because we needed to test and validate it, which we subsequently did with AyushEHR,” says Dileep.
AyushEHR is a clinical information management EHR product built for AYUSH healthcare practices. “There has never been such a system for traditional medicines. Even if it was there, it was difficult to share information. Now, if one person goes to an Ayurveda doctor and later to an Allopathic doctor, we now have a way of sharing health information between the two. This system is now being used in some resorts,” says Dileep.
He says this is important from the UN Sustainable Development Goal number 3, which mandates that by 2030 every global citizen should have access to affordable healthcare; and India is a signatory to it.
“Technology is the only way we are going to make it, especially for a country like India,” says Dileep. “One is we need to get everyone into the system. Then, we need to integrate other medical systems like Ayurveda, Unani, etc. into this. Because many people, especially in many small towns and villages, go for Ayurveda and other traditional systems.”
“With AyushEHR and e-Manas, we have been able to validate our system on two levels. Both are different use cases. Now, we are confident about it, and we opened it for healthcare application developers and startups in April,” he says.