By Ayush Jain, Co-founder and CEO of Mindbowser Global Inc
India’s pursuit of delivering affordable and universal healthcare to all its citizens faces a daunting challenge. While close to a billion Indians live in rural areas, 69 percent of hospital beds in India are concentrated in urban areas. The entire rural healthcare system grapples with neglect and disparity – even primary healthcare facilities are under-resourced and understaffed, failing to adequately serve around two-thirds of Indian population.
Financing is a key constraint. Per World Bank data, India’s GDP allocation for health was just 2.96% in 2020, falling well short of neighboring countries like China with 5.59%, and Nepal with 5.17%. Brazil in comparison spent 10.31% of its 2020 GDP on health. Rural communities are left disproportionately disadvantaged with little access to secondary and tertiary care. As a result, preventable diseases go untreated, and people often must travel long distances for specialised medical attention.
Many experts over successive decades have mooted the idea of using cutting-edge information technologies to reduce these disparities. Applications like telehealth and telemedicine have been tested and even proved successful in some ways, but the enormity of India’s geographical size and its population means that only a disruptive technological solution can make a real dent in improving healthcare access for all.
Digitalisation of all healthcare records via Electronic Health Records (EHRs) promises to be that solution. EHRs, like digital medical records or electronic medical records, are widely used in the West, but India continues to be a laggard in their adoption. Close to 100% of hospitals in the US, and an overwhelming majority of doctors (General Physicians) in the United States, Europe, and Australia already use EHRs. 4 Also, Australia’s national EHR system, ‘My Health Record’, covers nearly 90% of the country’s population 5 .
The Indian government is also encouraging widespread EHR adoption. The Union Ministry of Health and Family Welfare had notified Electronic Health Record (EHR) Standards for India in 2016 intending to introduce a uniform, standard-based system for creation and maintenance of these records. 6 Further, under the Ayushman Bharat Digital Mission, over 56 crores of Ayushman Bharat Health Accounts (ABHA) have been created so far, and over 34 crores of these have been linked to holders’ health records. 7 India has also incentivised the creation of new EHRs. Under the Digital Health Incentives Scheme, eligible health facilities can earn up to ₹4 crore worth of financial incentives based on the number of records created and linked to ABHA.
This is similar to how the US has incentivised EHR adoption over a decade, which has culminated in near-universal adoption. Still, India has a long way to go. Currently, fewer than 1,700 hospitals, clinics, or diagnostic labs have enrolled in the incentive scheme, per the government’s own data 8 . Majority of Indian hospitals and GPs either use paper-based records or proprietary systems that do not always adhere to the EHR standards, though the situation is changing slowly. The promised healthcare disruption will therefore slowly but surely unfold as EHRs of Indians grow in number, are fully kept up-to-date, and are made interoperable and shareable beyond proprietary systems. A pervasive adoption of EHRs will transform all key stakeholders, starting with rural Indians and healthcare providers.
When integrated with EHRs, next-generation telemedicine platforms could significantly improve remote diagnostics, consultations, and monitoring of remote patients, which will be particularly beneficial in underserved rural areas. Additionally, specialised tests like endoscopy can then be shifted to primary or community care settings, so actual specialists in metro or other big cities can manage and treat the patient remotely in a much better manner.
At an advanced level, AI-powered clinical decision support systems riding on the back of EHR systems could help physicians manage a much higher patient workload without compromising on the quality or accuracy of their diagnostics. This could be transformational for India’s universal healthcare goal given the sheer scarcity of qualified doctors in our country. Similarly, remote monitoring solutions integrated with EHR will have the capability to scrutinize health data generated by patients through wearables. This can facilitate the prompt identification of potential health issues, alerting healthcare providers and enabling timely interventions.
Going further, the application of predictive analytics on anonymised aggregate-level data stands poised to significantly contribute to the identification and mitigation of large at-risk populations through proactive preventive measures. This sophisticated application paves the way for a healthcare strategy that is comprehensive and yet targeted at the most vulnerable communities. The combination of AI and EHR will open whole new possibilities. Consider AI systems as the silent monitors of the EHR world, meticulously examining patient data to provide customised treatment suggestions and diagnostic insights. Moreover, Natural Language Processing skilfully generates organised data from the disorganised clinical notes, improving the precision with each step.
Finally, pervasive adoption of EHR also promises to usher in improvements in patient autonomy and engagement. By actively involving individuals in their healthcare decision-making process, the solutions will foster a sense of responsibility among patients, encouraging adherence to treatment plans and preventive measures. The transparency and accessibility provided by these systems can even alleviate the burden on an already overburdened healthcare system, and ultimately contribute to improved patient satisfaction and healthcare outcomes.
The possibilities with a nationwide EHR system are truly endless and it even has the potential to truly democratise quality healthcare for all Indians – bringing healthcare delivery in India at par with those of developed nations with much smaller populations. Accelerated adoption of EHR will surely help in bringing this dream to fruition, but so will suitable policy-level interventions that ensure its optimal utilisation by physicians and healthcare providers.
