Current Status in India
Indian healthcare informatics is at the point of inflection,with the government finally taking firm steps, towards becoming an active regulator and payor. The policy maker is finally in the process of becoming a facilitator for collaborative efforts for this massive exercise.
With a large number of players in this unregulated sector, Indian healthcare informatics solution providers are absolutely ill equipped to technically and financially manage the Herculean task of making the system interoperable. Technically it is always possible to build a new interoperability layer on existing systems or redevelop a new system that is interoperable by design. However, we must note that the leading private hospitals in India have a very minimalistic IT budget ( if at all they have a budget!) so let alone the govt and public health sector, where a requisition of a stethoscope may wait for months!
The result : Interoperability in India has become an academic topic only to be debated fiercely in various forums, where the experience of implementation is very limited or nil. Every vendor, actually deploying the solution and feeling the pain of ground reality, conveniently ignores interoperability; till it is an absolute must task, linked to reasonable revenue.
Some of us were part of various debate-hungry-forums, as well as implementation teams on ground, ranging from very small to very large deployments. Having enough insight of the challenges of Indian healthcare informatics vendor community, there was a compelling and spontaneous feeling in a few of us, that we need to change our approach to solve this ecosystem problem. We have witnessed that there is a spontaneous urge to solve the problem related to healthcare system interoperability, in the Indian IT community, comprising of solution architects, designers and developers. However, it is oppressed due to low priority for interoperability, within the organisation where they work. On the other hand there are a number of developers involved in overseas assignments, that are outsourced to India, who volunteer to offer their pro-bono expertise to build a national interoperable healthcare system, but they have no insight of the Indian ecosystem and its priorities. There was a very similar situation that created a legendary system like Linux, where the problem was thrown open to volunteers, unshackling a dormant collaborative force and the rest is history. So we, and anyone who joins us to contribute in any manner, understands and agrees that this is a movement in the national interest and we contribute voluntarily as individuals without any expectation at individual level or for the organisation / associations that we are part of.
In the past couple of years we have started to see the evolution of various standards that will form the bedrock of digital health adoption in India. In 2016, the EHR Standards were published, in 2017, we saw the NHP 2017 mention about the use of technology to be the lever to drive the improvement of various government initiatives. In 2018, with Ayushman Bharat and it’s adoption of technology to roll out the scheme across various states and beneficiaries we saw an added momentum towards the move towards the digitisation of healthcare In 2019, the National Digital Health Blueprint document was released that spoke about the use of APIs in sharing patient information within the healthcare ecosystem. Defining a three tier federated architecture at the national, state and healthcare facility level, we hope makes it even more important for the healthcare organisations to have in place the technology frameworks that will help in moving the patient health data out of the multiple silos it’s been trapped in and into the hands of its true owner, the patient Going forward we see an increase in the need for interoperability between systems not only within the hospitals or healthcare organisations but also between different hospitals, and healthcare organisations and most importantly the patients.
So, What is NCII
📌A collaborative initiative for Interoperability for Indian healthcare informatics
📌An implementation driven initiative
📌A community initiative, with participation from Private Sector, Individuals, Industry Partners, not-for-profits, government / regulatory bodies.
📌A collaboration of volunteers and industry partners coming together to form a “Linux for Healthcare Informatics”, that seeks to emulate the evolution of Linux operating system and other similar initiatives in India and around the world
📌A collaboration to record and create and define use cases where NCII can be implemented, we propose to create implementation guides for various use cases,
What NCII IS, NOT
📌 NOT a standards development body,
📌 NOT a legal entity
📌 NOT a proprietary activity
The key success ingredients are:
📌 facilitating reuse
📌 prioritising the work
📌effective compilation of tested work among the community.
During the CAHOTECH 2019, in Chennai we came up with business usecases that replicated the real life workflows that needed the participants to exchange the patient care continuum across the ecosystem of apps and applications. NCII plans to involve the geeks without any link / thread attached to their employers, but contributing scenarios and usecases that will enrich our the implementation guides that can be used by the Healthcare Technology Community to enable interoperability out of the box (instead of as an after-thought) in their own applications and solutions.
Today in India, an increasing number of patients are (not all but perhaps the tech enabled one’s) interacting with the Healthcare system in increasingly new ways.
Consider the following scenarios:
- Booking appointments on app to visit a doctor,
- Getting a consultation on an app, a Tele-consultation
- Place the order for Medications on her prescription, via an app
- Order for Lab test samples to be picked up from her home
- Lab results on app
- Order Medications on an online pharmacy
In India, the four five different apps listed above, at this point in time do not have the ability to allow the patient to share his /her Personal Healthcare Information, between each of these apps. These are some of the scenarios where a patient will benefit from sharing her information between the different apps in the Healthcare ecosystem.
While the Healthcare industry has been moving towards the adoption of technology, the pace has not been matching the promise, patients seem to have been more keen to improve their accessibility to Healthcare services than the Healthcare organisations’ adoption of technology. Doctors on the other hand seem to have taken to whatsapp sharing referrals, case notes, opinions and at times consultations with patients.
The increasing number of apps and applications in healthcare are only increasing the number of silos of patient information.
Planned Projects & Initiatives
NCII proposes to engage with various stakeholders in the ecosystem with different business cases such as
- CRM for hospitals
- Enabling Interoperability in brown field implementations
- Engaging with the government schemes for healthcare insurance usecases
NCII will continue to work with different stakeholders in increasing the number of usecases relevant to the Indian Healthcare Industry Scenarios. These will be continuously be listed here for the community to benefit from and add to based on their experience and workflows.
How to Contribute
NCII proposes to be an initiative that will allow, stakeholders collaborate early to enable restful APIs in their app or application frameworks thereby incorporating the “design to be interoperable” design philosophy that NCII proposes for the Indian Digital Health Ecosystem of the future
Reach out to our team:
Aniruddha Nene – https://www.linkedin.com/in/aniruddha-nene-627b475/ Manick Rajendran – https://www.linkedin.com/in/manickrajendran/ Kumar Satyam – https://www.linkedin.com/in/kumarsatyam/ Manish Sharma – https://www.linkedin.com/in/manishsharmas/
NCII – FAQ
We answer some questions you may have
Q1: How can Digital Health Ecosystem partners make use of the work done by NCII:
Vendors need to create a data structure within their back end to meet the requirement of Interoperability and the rest, ie the Vendor system should just choose scenario id of NCII and NCII id for the vendor system counterpart. Rest all will be done by NCII initially for the most common scenarios that would create a great traction. Later NCII will step back in value chain and slowly delegate the task of creating FHIR profile itself. Here’s where NCII can facilitate training by HL7 org. Again for the next series of commonly used scenarios. Lastly for specific and complicated scenarios vendors would come forward we just register the scenario id and they do everything and handover the message to us.
Q2: How can I participate? As a volunteer, company representative, industry partner representative?
The framework of engagement with the NCII project is as mentioned below
1. Volunteers steer the change.
2. All inclusive efforts with vendors, institutes, service providers, healthcare Informatics community, regularities. However participation of all stakeholder representatives without donning identity of any entity, will be purely as individual contributors.
3. In line with standards and regulatory guidelines and national health policies.
Usecases for Interoperability:
- Re-populating patient records In case of loss of care records during natural disasters like flooding, earthquakes, etc
- Patient Prescription Record
- Appointments Scheduling
- Healthcare Claims Processing
- Patient Health Registries
Reading List for starting with NCII FHIR Initiative :
To understand the genesis of FHIR and what is RESTful APIs mean, it will be really good if one were to read these articles:
1. Read about the RESTful API Architecture >>
2. FHIR Overview – Clinicians >>
3. List of BLOGs on FHIR >>
4. DOCUMENTATION on FHIR >>
5. HL7 FHIR VIDEOS >>
6. Understanding the STANDARDS PROCESS >>
BENEFITS of FHIR:
- Better Care Coordination
- Empowered Patients
- Resourceful public health registries
- Lower Healthcare costs
- Operational Efficiencies
- Improved safety and care quality
Definition: What is FHIR?
FHIR is a free and open standard for health interoperability, based on modern approaches, it consists of:
- A robust DATA MODEL for describing health and administrative data
- A RESTful API for interacting with that data using either JSON or XML
- A set of OPEN SOURCE TOOLS to implement and test FHIR applications
- A collection of FHIR SERVERS around the world that you can interact with
- A COMMUNITY of implementers working together