Tech Standards

One of the provisions of the proposed HDPSA is to bring in interoperability of electronic data captured and processed across different systems. This requires defined common standards for identification of health entities as well as different parameters of health data and also structuring of data transmission codes.

Probably we can look forward to new technical standards related to creation, transmission, processing and storage of data including adoption of codes for elements of health data which need to be monitored.

In 2013, the Department of Health and Family Welfare  (D-HFW) published the “Electronic Health Record Standards for India” and a copy was placed on the website for stakeholders to comment. The copy is available here.

 (A Revised version of the EHR Standards were published in February 2016 which is being incorporated into this document…Naavi)

The goals of suggesting the standards were indicated as follows:

  •  Promote interoperability and where necessary be specific about certain content exchange and vocabulary standards to establish a path forward toward semantic interoperability

  • Support the evolution and timely maintenance of adopted standards

  • Promote technical innovation using adopted standards

  • Encourage participation and adoption by all vendors and stakeholders

  • Keep implementation costs as low as reasonably possible

  • Consider best practices, experiences, policies and frameworks

  • To the extent possible, adopt standards that are modular and not interdependent.

Vocabulary Standards

Standardized nomenclatures and code sets were recommended to be used for parameters such as

a) Logical Observation Identifiers  Names and Codes (LOINC)

b) International Classification of Diseases (ICD-10)

c) Systemaized Nomenclature of Medicine-Clinical Terms (SNOMED-CT)

d) Current Procedural Terminology (CPT-4)

e) ATC- Anatomic Therapeutic Chemical Classification of Drugs

Content Exchange Standards

Standards used to share Clinical inforamtion such as Clinical Summaries, Prescriptions and Structured Electronic Documents such as

a) HL7-Clinical Document Architecture

b) HL7-2.5.1: defining the series of electronic messages to support administrative, logistical financial as well as Clinical processes using textual, non XML encoding synta based on delimiters

c) Continuity of Care Record (CCR), a record standard speficification

d) Digital Imaging and Communications in Medicine (DICOM)

Clinical Standards

Health Information Standards to capture a patient’s health information in a coherent manner which includes

  • The illness a patient is suffering from

  • The physician’s observation of the patient’s illness

  • The diagnostic tests that need to be carried out to ascertain the patient’s illness and to give the patient better treatment

  • The results of the diagnostic tests

  • The kind of treatment to be given to the patient

  • The way the treatment should be given to the patient

Guidelines

Guidelines were issued for hardware, networking and connectivity, software standards to be complied with the industry.

It was proposed that the maintenance of  health records should follow CCR standard XML file format, with demographics, insurance info, problem list/diagnoses, medications, allergy and alerts, vital signs, and lab results, consultation reports, hospital discharge and operative reports and investigative and diagnostic results (e.g. ECG reports, tread mill test results, biochemistry results, histopathological findings, ultrasound findings, etc.) kept current and accurate by a person’s healthcare team (nurses, doctors and pharmacists) which includes the patient.

Data Ownership of EHR

The Ethical, Legal, Social Issues (ELSI) guidelines for Electronic Health Record (EHR) were also recommended to define the Privacy and Security Requirements of EHR.

The detailed recommendations followed the principles of HIPAA in terms of defining the PHI, the data identity parameters  and the requirements of Privacy and Security.

The document was an indigenized version of HIPAA.

Now these guidelines may become operational if the HDPSA becomes a law.

Naavi