Implementing Electronic Health Records in India: Status, Issues & Way Forward

The Government of India has focused on digitizing its health care, including Electronic Health Records (EHR) to provide better patient data management, seamless coordination between healthcare providers, and improving healthcare research. This paper, based on secondary information analysis and a primary survey, discusses the policies to support EHR adoption in India, the status of EHR adoption the policy gaps, infrastructure barriers, financial barriers, and other obstacles. It provides the Government of India and the health service providers with recommendations to overcome the obstacles faced and successfully implement EHR systems. For EHR to be successful, there is a need for increased funding from the private sector, the government, and partnerships/collaborations. The paper suggests ways to streamline the data collection and compilation process and address the infrastructure gaps. It presents examples of how India can learn from global best practices of implementing EHR.


Introduction
As a developing country, with the second-largest population in the world, India has an ever-growing need for quality health care.
Digitalizing health care is one of the key objectives of the government to ensure equal access to treatment at a reasonable cost. The Indian government is also keen on affordable drug discoveries and health care research through the use of data generated in the country.
Electronic Health Records (EHR) are at the core of India's goals of digitalizing the health care system and moving towards Universal Health Coverage (UHC). India is taking cognizance of the benefits of EHR systems in terms of improved patient coordination, increased patient participation, improved medical research, and reduction in health care costs. In 2018, the Government of India (GoI) launched the UHC scheme, known as the Ayushman Bharat Yojana [1].This national health insurance scheme, has two main components.
a) The Pradhan Mantri Jan Arogya Yojana (PM-JAY) which aims to provide an INR 5,00,000 cover to the bottom 40 percent of the population for secondary and tertiary care [2] b) The establishment of around 1,50,000 health and wellness centers across the country for primary care, especially in rural areas. As a result, health data is being regularly collected for the said beneficiaries and there is a mandate from the government to digitize these records and take steps towards implementing EHR systems. Several national-level policies such as National

Policies to Enable EHR Adoption in India
India follows a quasi-federal structure of governance and health is a state subject in the Constitution of India. Therefore, it is up to the state governments' discretion to implement policies for-

Findings from the Primary Survey
Perceived Benefits of EHR Adoption: Our survey participants pointed out that by leveraging digital technologies, healthcare can be made affordable, accessible, and equitable. Additionally, it can a) Contribute to economic growth through increased investment, job creation and increase in exports of newer health products and services. b) Reduce reliance on imported medical devices.

c)
Allow for a more patient-centric approach. Figure 1 shows the top 5 perceived benefits of EHR implementation.

Barriers to Implementing EHR Systems in India:
The barriers to EHR implementations as identified by the survey and in order of their ranking is given below.  given below, which are essential for implementation of EHR.  In some cases, the staff themselves are not willing to enter patient data online as they pointed out that the number of patients per doctor is very high in India and data entry is time consuming.

D. Recommendations and Way Forward:
India may need to address the above issues, examine EHR models followed in developed countries, and customize the models to meet the requirements of the country. Some recommendations to address these issues are discussed below. to convert to structured data as defined by the repository should be implemented making health data easier to maintain. For identification, the UHID can be supported along with the Aadhaar card to provide more security in the form of dual authentication. For regions with low infrastructure, a process should be outlined to assist secure digitized data at regular intervals.  In this context, India can look at how some other countries have implemented their digitalization process and there can be more collaboration and partnerships through platform like G20 for which India is going to take up the Presidency in 2022.

Conclusion
The GoI and the Indian health care industry understand the widespread benefits of implementing EHR systems. As a result, they are committed to adopting these systems on a grand scale. As of date, the adoption of such systems is limited to the private health industry. Our survey identified several issues at the government and health care provider levels impeding the efforts towards EHR adoption. Based on the findings, we make recommendations towards increasing funding, focusing on business and government partnerships, streamlining the data collection process, enforcing minimum viable standards, and addressing infrastructure barriers to increase EHR adoption in the country. India can learn from global best practices of implementing EHR and customize it to the country's requirements.