Workflow and Interoperability approach to National eHealth Authority (NeHA) in India

Author: Manish Sharma

24 April 2016, Bangalore, India

The Ministry of Health and Family Affairs in India recently published a Concept note on the National eHealth Authority and called for comments and feedback on the formation of NEHA, India. All comments and suggestions can be emailed to on or before 20th April 2016.

NEHA is envisioned to be, to quote from the concept note, “a promotional, regulatory and standards setting organisation to guide and support India’s journey in eHealth and consequent realisation of benefits of ICT intervention in Health Sector in an orderly way”

Workflow Optimisation

While considering the implementation of DigitalHealth Solutions in India, its is very important to understand the “Workflow” of the patients and understand the Information requirements within the Identified workflows.

Since Healthcare has always been considered to be the “last bastion” to be Digitised for many years, the approach to Digitize Healthcare Workflows has always taken the “Traditional” approach, i.e., Go to the hospital, Study their workflows, gather all the current paper being generated and Digitize IT. And hence we came up with the “Paperless Hospital” approach.

But the flaw in the paperless approach, in my opinion is the approach that caused the creation of Information silos. We Digitised the Paper, and not the workflow.

Take for instance the workflow of a Doctor in a hospital. She is inundated with information which her training is able to Streamline as a workflow, but give the doctor a system, she is faced with a daunting task of having to “feed” the system with the information, because the system is not designed to help her streamline her workflow in her specialty.

The problem in the usecase of the doctor is that we have Digitised the feeding the information part, but not the workflow of the doctor-patient relationship and by that extention the care provider-doctor-patient relationships.

There have been many recorded and unrecorded cases of HIT implementations wherein the Clinical workflows are the last to be IT-enabled and at times not even enabled, due to this very reason.

World over the learnings of other National eHealth Implementations are definitely pointing towards the absence of patient and healthcare professional workflows being digitised, leading to dissatisfaction with the current Digital Health solutions.

Suggestion 1: 

NEHA should consider “Workflow Digitisation” in a Healthcare Facility as the driving force instead of Data Generation or Data Capture. It is important to identify and define the workflows across the healthcare organisation considering each care providers role and responsibilities. And to endeavour incorporating these workflows into the HIMS of the future.

Major and Minor workflows need to be identified and incorporated within the ambit of the pragmatic workflow optimisation, to ensure the relationship model between the care providers and the patients are well documented.

The Interoperability Red-herring

Most often than not, the main premise of setting up a National Level eHealth Authority in most countries has been to provide for “Interoperability” of information between the “Silos of Information” within and outside of the hospital.

As the report points out, Lack of Interoperability leads to “Ineffective Results”. 

In the discussion about Interoperability, I would like to for the need of discussion define “Exchange of Information” to be subcategorised as two specific areas

  INTRA-operability:  between Digital Health systems within the Hospital. Most vendors are contracted with the hospital and hence there is more control for the hospital management in this particular aspect, from a solutioning point of view.

INTER-operability: between Digital Health systems within the Hospital and “External” Digital Health systems that could be government bodies, patients, Digital Health Apps, etc. 

The above sub-categorisation can help in identifying areas of information flow and help the NEHA define the standards for each of the presenting usecases.

Consider the various Digital Health solutions within a Healthcare Organisation and you will realise the presence of “Standards” that each are specific to the type of Digital Health solution

For instance, 

  • a Laboratory equipment exchanges information via the RS232 port or RJ45 port in a ASTM format. 
  • A Radiology imaging platform deals with DICOM standards. 
  • The Patient Monitoring system in the hospital is a fortress of information, “Designed” to “Lock-in” the information that is “Proprietary” to the vendor that has supplied the system.

Just take the above three scenarios, and try and get a quote from a vendor to build you a system that “Integrates” all these three data streams (or information silos) into a patient’s EHR. It will be considerable. I would guesstimate 10-20% of the cost of ownership of a enterprise Digital Health solution.

Now, lets say you have been able to take up the implementation of such an “integrated” system, it took you a good year to stabilise your system with “INTERoperable” solution. And after the year of stability, you need to start sharing all this Information with the new app that has become famous with the patients.

Lets assume, that the new app is built on a standard that is different version (or perhaps proprietary) from the one that you have implemented during the past year. The entire process begins again to now “INTERoperate” with the new app.

Suggestion 2: 

I would suggest that the NeHA identify Digital Health information sources and fix the VERSION of messaging formats for each of these Digital Health Information sources for a period of 7 years so that all the sources of Digital Health Information are talking the same language without the need to constantly keep changing the standards of information exchange.

There should be a clear roadmap for version upgrades within the NEHA framework to allow for newer usecases but avoid changing the messaging format altogether year on year.

Streamline and standardise the INTERoperability and INTRAoperability standards for Digital Health Information sources.

As an additional step, it is important to mandate the implementation of common Digital Health Standards in all the Medical Devices that is OPEN and can be easily extracted from existing and new Medical Device implementations. 

Ideally, solutions, EHR products, medical devices and any other patient information generation device or software solution should adhere to a fixed set of standards, that allow for easy exchange of information.

Finally, NEHA can provide an Infrastructure to provide Open and Secure Digital Health Exchange Services/ APIs”. This will definitely remove the cost barrier to interoperability of Digital Health information.

I would suggest the use of “a Pragmatic approach to Interoperability” that helps NeHA identify and enable Interoperability of Digital Health information that provides the context in patient care. Physicians, Specialists and Chronic and palliative care experts should be consulted to define the usecases for patients need of Digital Health information. 

Questions to consider for Patient Information Inter / Intra Operability : 

  • Does the Doctor really need the “Womb to Tomb” record of a patient
  • What percent of patients need a “Womb to Tomb” record? 
  • Is it really possible to have such a record available, if one version of the HIMS is different than the other?
  • What percent of Patient’s benefit from Digital Health Interoperability?

To remove the boundaries between information silos in a Hospital workflow are the key aspects that should be identified and addressed in a pragmatic interoperability approach for an optimised workflow approach rather than a paperless or less paper approach


Manish Sharma

Founder, Digital Health Entrepreneur.

Additional Articles by the Author:

  1. Health ID as Patient IDs unifier in India  by Manish Sharma  
  2. 5 Steps towards an Integrated Digital Health Experience in Indian Healthcare in 2016 
  3. Top Healthcare & Digital Health Predictions for 2016
  4. Zen Clinicals: An Activity & Workflow based solution (1 of 3)
  5. RFID in Healthcare: Usecases from Hospitals
  6. 10 Solutions for the Healthcare IT Fringes

Suggested Reading:

  1. CHIME Calls for More Transparent, Uniform Interoperability Standards for Medical Devices
  2. The future of depends upon the secure exchange of electronic data – Deloitte Healthcare
  3. Pragmatic interoperability: Interoperability’s missing workflow layer | Health Standards – Dr. Charles Webster ( @wareflo on Twitter)

Strategies to Foray into Digital Health by @JPpattanaik

Author: JP Pattanaik, Sr. Business Analyst & Akanksha Rajeev, Business Consultant

in this article, provide an insight to various strategic options for Indian IT product-centered organisations to consider foraying into healthcare industry

The article was first published in Express Healthcare, Feb 2016 Edition. The article is republished here with the authors’ permission
24 Mar 2016, India


The lucrativeness offered by the healthcare IT industry has brought significant attention worldwide. Healthcare industry is considered ever green and healthcare IT has attracted the attention of global players for investments. There are a section of players who are pioneers in the industry and have recorded significant growth. At the same time there are laggards who want to build such capabilities and tap the untapped market following the recent industry trends and success stories. Healthcare IT organisations have to cope with transforming business model while adhering to strict regulatory demands of the industry. They need to carefully adopt strategies based on the organisational maturity, capital and the time they have for go-to-market. In pursuit of quick success, often organisations commit mistakes choosing the right approach while building potential health IT product capabilities. This article highlights different strategic options for Indian IT product-centered organisations thinking of foraying into the healthcare industry
Global Healthcare and Healthcare IT spending trends

According to industry estimates, the global healthcare spending is expected to grow at an average of 5.2 per cent year on year during 2014 – 2018 to a total of $9.3 trillion. In spite of its vastness, both developed and emerging nations are dealing with issues like ageing population, rising incidences of chronic diseases, rapidly increasing cost of healthcare, disparity in quality of care, infrastructural challenges, workforce shortage, non-uniform distribution of healthcare facilities across the community locations etc. The burden faced globally today has never been so challenging than ever it was.

An estimate by the Economist Intelligence Unit (EIU) the regional healthcare spending during the year 2015 is expected to be as given in the table.
Globally, most nations have been challenged to improve quality of care while reducing the cost of healthcare by means of inventing cost effective methods for an optimal outcome. The challenges described above have led to adoption of healthcare IT solutions such as Electronic Medical Records (EMR)/ Electronic Health Records (EHR) for safe storage of healthcare information and to make more informed decision.
According to an estimate by MarketsandMarkets, a leading research organisation, the global healthcare IT market is estimated to reach $56.7 billion by 2017 — up from $40.4 billion in 2012 — due to the demand for clinical information technology, administrative solutions and services. Among the various healthcare IT solutions offered, EMR/ EHR segment dominates the sector.
Gartner estimates healthcare providers in India are likely to spend $1.2 billion on healthcare IT products and services in 2015, a seven per cent growth over 2014. Software spending is likely to grow 6.2 per cent to reach $103 million in 2015, up from $97 million in 2014, led by growth in vertical specific software. An estimate by Frost & Sullivan, healthcare information technology market in India is expected to reach $1.45 billion in 2018 mainly due to fast adoption of technology by stake-holders. India being a developing nation, the health IT spending is still much less than that of the developed nations. The rest of the paper discusses various drivers for healthcare IT initiatives, its attractiveness and approaches for Indian health IT organisations for an effective go-to-market strategy.
Drivers of Healthcare IT in India 

Some of the major factors contributing to the growth of healthcare IT globally are listed below:

  • The continuously growing pressure to cut healthcare costs
  • Need for care coordination and management demanding integrated healthcare systems
  • High rate of return on investment in healthcare systems
  • Financial support and incentives from the government
  • Growth of medical tourism
  • Government initiatives, conducive policies for the sector
  • The rise in the ageing population
  • Growing demand of health IT products to reduce medication errors
  • Rise in incidences of chronic and lifestyle disorders
  • More informed and engaged patients.

Why do more and more Indian IT organisations want to venture into Healthcare Industry?  
Healthcare has a huge addressable market. India as a country has witnessed a rather steep growth trajectory only in the last decade with the advent of the private sector. The influence of technology has been an important growth driver, with healthcare models based on IT intervention now becoming a reality. The accessibility of healthcare today is more than it ever was, consequently increasing the opportunity for new players. Emergence of new delivery models which are scalable, less capital intensive and yet promise better earnings is one of the major reasons the healthcare sector has lured the investors. Diagnostic chains, single speciality clinics, wellness centres, primary care set-ups etc. are all emerging models of healthcare and it is still evolving. In a nutshell, healthcare industry provides array of opportunities for new experiments at a promising return on investments. The penetration of healthcare IT is still in its infancy providing ample opportunities to all competent healthcare IT solution providers. With increased importance to healthcare needs, the adoption of modern healthcare IT systems is bound to grow.

Approaches for Go-to-Market  

In order to tap the business opportunity presented by the IT enablement of healthcare institutions, the IT organisation should evaluate options and consider one that suits the best. A single approach may not fit all. In pursuit of quick success, often IT organisations opt for suboptimal options, which may not meet their long term objectives. Following are the three strategic options to realise the business opportunity presented by healthcare IT market:
  • Approach 1: MODIFY Enhancing an open source software
  • Approach 2: CREATE Building a greenfield system
  • Approach 3: ACQUIRE Acquiring a licensed product

The table below provides the advantages and disadvantages associated with each of the approaches.
An organisation should evaluate the functional, technical and business capabilities while prioritising a strategic approach. Each of the approaches can be evaluated based on the following parameters:

Cost and effort
Total cost of ownership (TCO): Total cost of ownership refers to the cost to the organisation for sustaining a product line. This includes the license fee for the product and cost of the application maintenance and support.
Effort: This is the effort that needs to be put in by the organisation to meet the desired product criteria driven by Customer/ Market needs.
Potential Revenue: This refers to the revenue that would be generated by the organisation on entering the market with the stated product.

Market factors
Time to market: This is the time taken to launch the product in the market for customers.
Market acceptability risk: The risk that the product launched into the market is not accepted by the clients. This is particularly high for a new product launch.

System related factors
Customisability: The capability of a system to be easily customised for desired features. Creation of a greenfield system offers the highest amount of flexibility as it can be designed keeping product expansion in mind.
Scalability: The capability of a system to be easily scalable for larger implementations. While a greenfield system can be designed to be scalable an open source or acquired product may have limitations.
Skilled resource availability: The major constraint of a system is the technology stack that it is built on. Having technically sound resources trained exclusively on the same platform is one of the major factors for system selection.
Legal/ IP Risk: Enhancing and commercialising existing open source systems would give rise to potential legal risks. Some systems are covered under various public licenses which prohibit the commercial use for profit.
Security risk: With the ever growing population that is being catered through the IT enabled system, security of the healthcare data plays a vital role in the evaluation of a system. Many laws of the land mandate patient privacy and prohibit the transfer or usage of the healthcare data and thus require utmost authorisation and protection for the same. Any shortcomings in the system that compromises patient data security would pose a security risk.
The evaluation of each of the approaches based on the above mentioned parameters are summarised in Figure 2.

Key Considerations  

A greenfield system though requires investments, is a safer approach as it minimises some the risks demonstrated in other two approaches. However, all organisations may not be in a position to have proprietary systems to exploit the immediate market opportunities presented. The pioneers always have the advantage to exploit the market opportunities with less competition. New players should carefully choose the market segment they want to make an entry. When an organisation lacks significant market presence and experience, it may be recommended that the organisation should take baby steps and stay profitable yet. A big bang approach may not support the ultimate objectives of the organisation. In this context it may be recommended to health IT vendors that the
Approach –‘MODIFY’ can be considered as a short term strategy with an objective of learnings, small scale implementations and R&D.
Approaches – ‘CREATE’ and ‘ACQUIRE’ can be considered as long term strategies with an objective of achieving the vision of the organisation.
Approach – CREATE demands investment in terms of time and ensuring the product exceeds expectations than a competing product while 
Approach – ACQUIRE enables the organisation a quicker go-to-market for realising the opportunities. However, the risks associated with the approach must be given due consideration.


The lucrativeness of the healthcare IT market has received significant attention. It is an obvious choice to exploit the opportunities presented. The pioneers and the laggards are equally keen to make the best of the opportunities. An approach that works best for a pioneer may not be of same value to a beginner. In pursuit of quick success, organisations should not commit the mistakes of engaging in a wrong approach to make a foray in hurry. It has been rightly said, “There is no shortcut to success.” Organisations need to carry out a risk and return tradeoff before formulating and executing any strategies for the best possible outcome.


i. 2015 Global Healthcare Outlook. Common Goals and Competing Priorities By Deloitte, Whitepaper, 2015.
ii. Global healthcare IT market estimated to reach $56.7B by 2017 By Ashley Gold, News Article, FierceHealth IT, May 10, 2013.
iii. 2014 Global health care outlook: Shared challenges, shared opportunities By Deloitte, Whitepaper, 2014.
iv. Overview of International EMR/EHR Markets: Results from a Survey of Leading Health Care Companies By Accenture, Whitepaper, August 2010.
v. Healthcare IT market in India may touch $1,454 million: Study
vi. IT spending by Indian healthcare providers may rise 7 per cent in 2015, Gartner says

Disclaimer: The ideas and opinions shared in this article are personal views of the authors and have no bearing or impact on the official policy or position of United Health Group or its entities


JP Pattanaik

Healthcare Management and IT Consulting
Akanksha Rajeev

Healthcare Management and IT Consulting

Top #DigitalHealth Trends to expect in 2016 by @AmandaShaffer14 @pankajguptadr

Author: Amanda Flowers & Dr. Pankaj Gupta

The article was first published in Healthcare-IT Business Strategy. The article is republished here with the authors’ permission
17 March.2016, India

The Technology has transformed healthcare around the world at a faster rate in the last few years than at any other time in history. There are many exciting innovations poised to help improve patient outcomes and the landscape of healthcare as a whole over the next few years. For 2016, we can expect to see the following IT driven changes in India:
Expanding Telemedicine Services

The telemedicine market in India is expected to reach a valuation of about $18.7 million by 2017, according to Deloitte. Since telemedicine makes it possible to provide needed medical services from a distance, this may be particularly helpful for individuals in rural communities that do not have access to the larger hospitals and centralized facilities. Medical professionals can provide advice to patients and can even consult with patients about specific issues using video chat options.
Greater Integration of SMAC

SMAC, standing for Social, Mobile, Analytics, and Cloud technologies have transformed every business in India and around the world and healthcare is no exception. As medical facilities get on board with using social options, patients will be able to interact with their doctors and obtain information about their health and well being in new and convenient ways. Analytics in healthcare will allow information to be analyzed and cross referenced, assisting with research and outcome improvement.

Mobile integration puts health information at the patient’s fingertips in a way that was not possible in the past. This may help improve outcomes and communications between medical providers and patients in countless ways as the shift to mobile is embraced. The movement from client server to cloud is shifting the industry IT vendor landscape, with many smaller and newer vendors beginning to replace large vendors that have traditionally assisted with IT needs.
Increased Use of Medical Wearable Devices

The use of health and fitness wearables has increased substantially over the past few years and is expected to continue to increase at an ever-faster rate until about 2020. Start-up companies are experimenting with creating wearables featuring health IT features. We may see prototypes emerge this year that allow patients to instantly send remote information about biometric data that is obtained using sensors in various medical wearables. This could allow physicians to spot medical issues much faster.

Improved Mobile Access to Health Insurance

Private health insurance covers about three percent of India’s population. The government health plan covers about eight to nine percent of India’s population, while the rest is paid out of pocket. In 2015 the Parliament passed the Insurance Bill where the FDI in Insurance was raised to 49 percent and health insurance has been declared as a separate business. Also 100 percent FDI was allowed in medical devices. These two policy changes will bring a boom to the mHealth and health insurance market in 2016-2017.We predict Insurance support for mHealth solutions including outpatient visits and chronic disease management or non-communicable diseases [NCD] as it is called in India.

Many companies now also allow individuals to apply for health insurance using mobile apps. In 2016, we can expect to see even greater competition in the industry with more mobile access and improvements in automating the claims process.
More Complete Patient Histories with EHRs

EHR and MDDS for health domain standards were notified in September 2013 and approved in December 2013, respectively. As medical facilities adjust to using systems to keep electronic records, we can expect to see more complete patient histories begin to affect outcomes and standards of care. This is especially true across borders, as many developed nations are now employing the same standards for coding and keeping EHRs. We may see 2016 bring forth improved software that simplifies electronic record keeping, transitions of care, coding, and billing.

Widespread Adoption of Surgical Robots

India has been behind the ball in adopting surgical robots for some time now, but we may see many more robots flood the hospitals this year. Intuitive Surgical, the creator of the U.S. based da Vinci surgical systems, considers India an important market. The Vattikuti Foundation plans to increase the number of surgeons trained to perform robotic surgeries from about 147 currently to 300 by 2020.

IoT Revolutionizing Patient Care

The Internet of Things is an extremely beneficial addition to the medical industry. We expect IoT platforms to emerge that will enable integration of all healthcare applications, devices, and things. Health monitoring devices can track vital patient information such as blood pressure, heart rate, and blood sugar levels every single day and communicate this information to medical professionals. Pacemakers and other medical devices can also be connected so that information is transmitted daily and not just during doctor visits. Medical professionals can directly communicate when information is worrisome and can save time from running unnecessary tests when health signs are good.
CRM Improving Patient Relations

Customer relationship management has always been important, but is now easier than ever because of SMAC technologies and EHRs. Doctors can communicate more freely with patients and can track all interactions for future review. These options will help make doctor/patient relations more personalized. A personalized approach will improve patient satisfaction and may also help to improve outcomes.

Article By: Dr. Pankaj Gupta

Digital Health Influencer & SMAC / IoT Speaker | Healthcare Business Executive, Chief Medical Informatics Officer at ProMed Network AG | Managing Partner at TAURUS GLOCAL CONSULTING | Director at Taurus Globalsourcing Inc.
Amanda Flowers

a graduate in Psychology, with minor in English Literature and Public Health. She draws on her knowledge of these subjects to create online content that addresses human needs in a simple way. Flowers is currently a freelance health blogger and working for Blue Cross Blue Shield of NC

#Infographic : 7 Types of Cyber Threats

  • 61% of business leaders see cyber as a serious business threat, 
  • 140 countries business leaders say cyber threats us highest concern
  • $445B estimated annual toll of cybercrime on global economy
  • 67% of enterprise organisations believe that the threat landscape is worse today than it was 2 years ago – ESG: Threat Intelligence as part of Cyber Situational Awareness
Cyber Threats have been increasing over the past years. It is important to therefore understand what are the types of Cyber Threats that one must guard against, personally and as an organisation.
We prepared this Infographic from an article that appeared in Healthcare IT News, by @SullyHIT titled ‘7 cyber threats worst than PHI a summary of Richard Clark’s talk’


Team HCITExperts

Your partner in Digital Health Transformation using innovative and insightful ideas

New Healthcare Aggregators: SMAC and IoT via @pankajguptadr

Author: Dr. Pankaj Gupta

Digital Health Influencer & SMAC / IoT Speaker
15.Feb.2016, India

The old paradigm of business as a linear value chain is now facing extinction. Businesses are now ecologies and not merely producers and sellers ! That requires a change in thinking. Customer Relationship Management (CRM) needs to be a mission at every step of the process. This is hard to overemphasize! The internet is clearly the medium that allows such integration across time and space. It is time to take a more accepting look at Cloud and Social Media technologies. This offers the only universal layer of engagement across stakeholders. The investment in IT hardware as we new it in the past has been greatly optimized by mobile. It has brought a tactile feel to life and work for all of us. Mobile mirrors the nature of Healthcare in terms of immediacy and continuity so well. Healthcare needs to embrace it wholeheartedly. Healthcare can only profit from it.

There is a huge Vacuum in Indian Healthcare-IT space. Large Healthcare-IT vendors have exited the market. Either they lost interest and exited or got bought out e.g. TrakHealth, iSoft. Also the market is moving from client-server to cloud and from Capex to Opex models. New cloud based players are small in size and yet to reach enterprise class. Existing players are not able to shift out to cloud because of their long term negotiated contracts in client-server model. The time is now when full conversion of Enterprise class to SMAC will happen anyways. Healthcare CIOs can keep eyes closed or tighten the belt and ride the Digital wave.

Recently I spoke to a Director of State NHM in India. He said we are doing HMIS and Public health through ANM/ASHA. How do we benefit from SMAC IoT platform? Hard for many to imagine SMAC is a unifying force across enterprises and IoT breaks the silos. This can be quite unnerving for many. 

The era of hierarchical command and control is over. Now is the time for horizontal networking across Communities of Practice [CoP]. Whatever gets the maximum likes becomes the In Thing. Whatever is the In Thing gets used the maximum. Students are learning more from the online networking than from the formal classroom and professors. Research will reach the point of use as soon as it gets published. Primary care Providers in semi-urban and rural areas will have access to latest therapeutic recommendations. The old Adage that ‘Knowledge is the only form of power that is not expendable but grows when shared’ has become true.  

The movie Avatar has beautifully depicted the concept of Small data ^ = Big Data where small knowledge base of each living being [App] is contributing towards the collective consciousness [Big Data] of Eywa. Now the question is will the future of SMAC/IoT be driven by technology or biotechnology?

Anyways for now – The time has come when you don’t need big monolithic HIS software to run hospitals. Now you can do everything with small mobile based Apps for every function. Though I am already seeing many of these Apps in the market but what is lacking is a unified platform on which the Apps should be built such that the data can be seamlessly collated. Also it gives the provider the flexibility to select from a bouquet of Apps. 

IoT integration platforms are emerging that will integrate at the App level, Data level and Semantic level. Anyone in the ecosystem can slice, dice, run reports on the collated data.

Successful Cloud models have dug the grave for the Enterprise Hardware. Capex has got converted to Opex. Now you can pay for the software on the cloud like you pay your monthly electricity bill.

SMAC coupled with IoT has a potential to bring the Aggregator Business model to Healthcare. Soon the unorganised and fragmented primary care, secondary care and supporting care market will begin to get Aggregated. I see these Aggregators becoming larger than established capital intensive Enterprise market similar to what happened in the Automobile market. It will be in the interest of Insurance, Pharma and Govt to go all out and support this emerging SMAC/IoT driven Healthcare Market Aggregation.    


Why Healthcare must Re-imagine itself – and how
Why All Indian Hospitals IT is in Bad Shape
Global HIS/EMR vendor nightmare outside US
Thick client vs Thin client
There is no Market for EMR in India
Size of Healthcare-IT Market in India 

Please note: The Author of this article is Dr. Pankaj Gupta. The article was first published on Dr. Gupta’s blog. And also on Dr. Gupta’s LinkedIn profile :New Healthcare Aggregators: SMAC and IoT | Dr Pankaj Gupta | LinkedIn

Article By: Dr. Pankaj Gupta

Digital Health Influencer & SMAC / IoT Speaker | Healthcare Business Executive, Chief Medical Informatics Officer at ProMed Network AG | Managing Partner at TAURUS GLOCAL CONSULTING | Director at Taurus Globalsourcing Inc.

Revolution In Healthcare via @SelfCareGuru

Author: Joao Bocas 

Digital Health Influencer & Wearables / IoT Speaker
10.Feb.2016, London, UK
The emergence and increased severity of chronic illnesses around the world has grown to exponential heights in comparison to the last fifty years of medical analysis. The existence of chronic diseases are crushing the Healthcare sector and the resources therein, and subsequently creating socioeconomic issues within the diaspora as the government, patients and insurers are faced with the burden of paying higher costs for medical services. We have a major crisis on our hands, one which not only declines the population’s status of health, but also lowers the potential productivity of said populace. In light of the aforementioned, it is in the best interest of all to revolutionize the current Health Care systems in hopes of changing the trajectory of the potentially disastrous outcomes. 

Around the world, unhealthy lifestyles and aging populations have strongly influenced the constant recurrence and prevalence of chronic diseases. This category of illnesses place a strain on healthcare providers and the healthcare system at large, due to the high volume of hospital visits and admissions by ailing patients. Strategically speaking, healthcare providers have what may be considered as a normal range of activity within which patients are anticipated to operate. However, those who require long and resource-intensive treatments undoubtedly use up intensive care resources that were initially set aside for the interest of other insured patients. This growing problem has led to the drastic reduction in available resources and the imposition of limitations in regard to certain treatments.

Tactics employed to protect health care systems and their resources have sufficiently lessened the availability of the once prevalent resources, and in direct proportion, have increased the growth of people with chronic diseases. In the near future, it is clearly foreseeable that if no radical intervention is initiated, this downward spiral will only increase the intensity of the detrimental effects suffered by all involved. 

Sadly, despite the wondrous advances in medicine and technology, health care continues to fail as it is unable to provide what its customers truly need. Regardless of the increasing complexity and best intentions of doctors and nurses involved, they can no longer guarantee the provision of the best care practices to ailing patients. Fixing health care will most definitely require a radical shift from current health care practices that are individual based, to a strategic approach that embraces a team-based way of work.  Although many physicians are anxious about the reduction of money, autonomy and respect; accepting new organizational structures, payment models and performance goals; could possibly create a level playing field for both insurers and patients. 

To catapult this change, leaders from all sub-divisions of health care must draw on their reserves of courage, resilience and optimism; and stand up for what they believe in. They must make it a point of duty to be aware of the economics and social capital relations which define how they are paid, and be willing to cut ties with companies who are solely driven by monies acquired as opposed to the improvement of outcomes and efficiency of service.

Conclusively, in the writings of sociologist and economist Max Weber, four major considerations of social action which have been adapted for healthcare improvement includes: shared purpose, self-interest, respect and tradition. These levers may be manipulated to bring about the changes, which the system so desperately needs

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Please note: The Author of this article is Mr. Joao Bocas. For resharing the article, please contact Mr. Joao Bocas or the HCITExpert Admin via our contact us page.

Article By: Joao Bocas

Digital Health Influencer & Wearables / IoT Speaker

Health ID as Patient IDs unifier in India

Health ID as Patient IDs unifier

06.Feb.2016, Bangalore, India

The post discusses how a Health ID can be linked to Aadhar Number

Unique Identifiers, Health ID & Aadhar Number

A unique identifier from a database technology standpoint, is the ability to create a primary key and link all the data in the database using a primary key (parent record) & foreign key (child records) concept.
Keeping this concept in mind using Aadhar Number as a Health ID offers a very compelling opportunity to uniquely identify a patient across multiple episodes and visits, in a single facility or across multiple facilities (that may be located in same geographical location or multiple geographic locations)
In most Health Information systems, the records of a patient are tied to a Unique Patient Identifier, a Patient ID or a UHID.
Let’s consider what are the various use cases of the Aadhar Number and a Patient ID.

Aadhar Number

The Aadhar Number has been planned to be used by the government for various welfare and direct benefit transfer schemes. There have been many instances that the Information that has been recorded in the Aadhar ID may or may not have the latest information of the person carrying the Aadhar Card. The purpose for which the Aadhar Card has been created is to identify a person for various government schemes and also has been deemed to be used to be provided at the time of opening of a bank account. Hence there are quite many financial transactions that might be linked to the Aadhar Card.

Patient ID or UHID Number

The Patient ID in various Healthcare information systems, is generally used to uniquely identify a patient so as to deliver various services for the patient at the right place and the right time and to the right person. And also link all the healthcare information about the patient to this unique identifier.
Keeping in mind the need to uniquely identify a patient and to avoid duplicates becomes a very important factor in the Hospital Information Systems.
In a specific system ( and these obviously vary from one HIMS to the other) the Patient ID is utilised to keep track of various types of patient related information or healthcare events. In addition to the Patient ID, there is the Episode ID and the Visit ID information that is used to store specific visit related and diagnosis based information in the Health Information System. In these systems, the Episode ID and the Visit ID are used as the child records of the Patient ID.
Most Health IT systems employ an algorithm to identify patient duplicates based on various data points creating a complex key.

Using Aadhar as a Health ID

In various countries around the world, the use of a single identifier as a universal identifier has never been successful due to the complexity & security concerns of the various use cases.
Take for example the case of the SSN (Social Security Number) in the US. The SSN is recorded for the patients in the Healthcare Information Systems but is never utilised to uniquely identify a patient due to the issues of Security and Identity theft. There are a lot of instances in which the SSN has been stolen and leads to the person suffering from stolen identity.
Healthcare Information systems have been hacking targets and currently the losses estimated in every hacking incident runs into millions of dollars.
Now take the example of Aadhar ID as a Health ID. We might land up having similar issues of the healthcare information system at a hospital/ clinic being hacked into and the Aadhar information being misused by the hackers.
Obviously, the security levels of an IT infrastructure at a hospital or clinic will not be as superior as the competent authorities security and IT infrastructure.
The government agency will be able to ensure the security of the Aadhar number, by providing robust and secure systems, but the same may or may not be expected of the Hospital Information System vendor or the hospital or a clinic that has implemented the solution or for that matter a Health Information Exchange authority. 
  1. Use Aadhar to validate the Identity of the Patient, Only

The Aadhar number must be used only and only to validate and authenticate the Identity of the person who has come to the hospital. Aadhar Authority could provide a service that could be called to authenticate a person.
  1. Use Health ID to be the Primary Key, Patient IDs to be the Secondary Key

In the absence of standards as to how the Patient information is to be stored within a Healthcare Information Management System or EHRs, it is more advisable to maintain the Health ID as a Primary Key, the ownership remains with the Health Authority. However, each visit that a patient makes into any healthcare facility, the HIMS/EHR/EMR vendor generates a care summary record (using Patient ID) as a “Secondary Key” information for the patient.
This is akin to how each bank might have different banking information systems, but the PAN number is a unifying information to understand how many bank accounts a tax payer might have (since PAN number is mandatory for every transaction done).
In this bank scenario, the PAN is the Primary Key, and every transaction done against the PAN card is the secondary key.
The authentication of the PAN is done by the competent authority who develops robust systems to safeguard the PAN card information of the PAN Card holder.
  1. Patient ID/ Health ID should be maintained by the Health Authority (e.g., the National Health Portal)

We propose the Health ID should be maintained by the Health Ministry in the government and the various aspects of Health Information should be defined by this authority. Since the Health Information of the patient needs to interoperate between the Hospitals/ clinics (which comes under the Health Ministry) and the Insurance Companies (which is another government department), maintaining a separate Health ID with its own security and interoperability guidelines is an appropriate approach.
The interoperability between the various government departments is more easier than any other third party vendor implementing such a interoperability system. The government therefore becomes an enabler of interoperability between various consumers of the healthcare information (in this case, the insurance companies and the Hospitals)
For instance, the Health ID could have a one-to-one relationship with the Aadhar Number. But the contents of the Health ID related information can be dictated by the Health Ministry or the National Health Portal Authority.

In Conclusion

  1. Health ID should be used to maintain a persons’ Health Record across the care continuum.
  2. Health ID can derive the Demographic information from the Aadhar ID and use the Aadhar ID for Identity matching, duplicate check and person authentication services.
  3. There should be a one-to-one relationship between Health ID and Aadhar ID.
  4. Each time a patient makes a visit to a healthcare facility, the Health ID information regarding the patient will be updated. Mechanism to be worked out if the current and latest information gathered from the patient regarding the demograhics should be updated back to the Aadhar Information.
  5. For Healthcare Related information, Healthcare Information Exchange purposes, Health Insurance purposes; the Health ID should be the unique and Primary Key.
  6. The Patient ID or UHID captured in each of the system should be treated as the Secondary key or the child records that will help put together the patient visit related information.
  7. We can now move to a National Level Health Information Exchange to store health data for the Patient’s clinical events across healthcare facilities, against a Health ID


  1. Limiting the Use of the Social Security Number in Healthcare –
  2. Patient Identification and Matching – Final Report –
  3. National Patient ID System: Debate Stoked – InformationWeek –
  4. HIMSS Asks Congress for Patient Identity System–Again – InformationWeek ––again/d/d-id/1106498?
  5. National Patient Identifiers | Practice Fusion  –
  6. Identity Crisis: An Examination of the Costs and Benefits of a Unique Patient Identifier for the U.S. Health Care System | RAND – 
  7. Creating Unique Health ID Numbers Would Facilitate Improved Health Care Quality and Efficiency | RAND – 
  8. Patient Identification in Three Acts –
  9. National patient identifier struggles for life | CIO – 
  10. White Paper on Unique Health Identifier for Individuals
  11. The Imperative of a National Health Identifier | HL7 Standards –
  12. Are we ready for national patient IDs? | HIMSS Future Care –

    Suggested Reading

    1. Unique Identification Authority of India –
    2. Aadhar: A number to facilitate the lives of the next billion | Dr. Pramod Varma | TEDxBangalore – YouTube
    3. Linking Aadhar to better Healthcare –
    4. Authenticating Indian eHealth System through Aadhar: A unique identification –
    5. A secured model for Indian eHealth System –
    6. The Aadhar for mass health insurance –



    Manish Sharma

    Founder, Digital Health Entrepreneur.

      5 Steps towards an Integrated Digital Health Experience in Indian Healthcare in 2016

      In 2016, we expect Interoperability, Move to the Cloud, Connectivity Data and Analytics Trifecta, Personalised Digital Health Services will dominate the Digital Health Landscape in India


      Fard Johnmar, describes 2016, as the “Age of Implementation”. Bringing the inflection point of providing services to customers of healthcare; by moving from treating the ‘patient’, to providing  services to the ‘customer’ across the continuum of care. In my opinion the Indian Healthcare Providers should be focussing on these areas in 2016

      Efficiency in Workflow, Speed in Communication will be the key implementation factor


      Indian healthcare providers have implemented solutions that have the ability to capture the patient demographic, test results, clinical summaries and financial data. This data resides in the Hospital Information systems as silos and there is a need to implement interoperability solutions that allow for the exchange of the patient data between the healthcare information systems and Digital Health solutions like a patient CRM, mHealth solutions, medication reminders apps, appointment scheduling solutions, telehealth etc.

      Absence of interoperability between existing solutions in the hospital and other connected solutions required to enable an Integrated Digital Health experience for the patient, causes duplication of work, information silos and data information errors. Interoperability should become a de-facto feature provided by the vendors with APIs and interface capabilities using Standardised formats, i.e., HL7, CDA.

      Since the billing and insurance information is being captured by most of the providers, we believe there can be paperless electronic claims processing capabilities that can really drive the adoption for interoperability in Healthcare in India.

      Move to the Cloud

      More enterprises and specialty clinics will put into place strategic partnerships towards enabling a cloud infrastructure. The needs of each of the Healthcare providers is different and varies from specialty to specialty.

      With the need to orchestrate between multiple systems the Healthcare Providers will have to work on putting in place long term strategic partnerships with Solution Developers and system integrators.

      Such partnerships will allow for a continuous evolution of their Digital Health solutions that will enable the Healthcare Providers to Innovate in the “Agile” way, while delivering a personalised experience and always operating in the real time for service delivery requirements

      Connectivity, Data and Analytics Trifecta

      Digital Health solutions will be implemented providing connectivity to the customers with the range of services offered by the Healthcare Providers.

      With the availability of the Data, the Healthcare Providers will be able to personalise the offerings for each customer, since the requirements for a customer in need of a Health checkup is completely different from a patient in need of chemotherapy.

      With the availability of the data, the Healthcare Providers will be able to continuously improve the offerings to each segment of the customer by utilising actionable intelligence.

      Personalised Digital Health Services

      The patient of today wants faster access to services, personalised experiences, 24/7 access and connectivity and access to these services from a host of devices. To meet these expectations Hospital providers in India will start to engage the patient via multiple channels by implementing  Patient Engagement Services with a focus on a Multi-channel approach required to deliver alerts, messages, video visits, email.

      More and more hospitals have started having their presence on the Internet and Social Media. In 2016, the hospitals will leverage this presence and offer a real Integrated & personalised Digital Health experience to their customers.

      Integrated Digital Health platforms can provide specialised, focussed and personalised solutions for curative care and preventive care.

      Healthcare Apps

      Indian Healthcare providers will offer their services via Healthcare Apps to provide an integrated Digital Health experience to their customers. These apps will be used to provide medication reminders, personalised healthcare advice, appointment scheduling for doctors and services, telehealth for followup care. The Healthcare Providers will work towards implementing mHealth 3.0 services, the next level of mHealth capabilities.

      From Indian Experts

      Some of the experts too chimed in on their strategic opinions for Digital Health in 2016:

      Dr. Ruchi Dass @drruchibhatt, MD Healthcursor Consulting Group, stated her priority areas as, “Get “Healthcare delivery” – a fundamental reset. Brings a dash of frugality to medical innovations.”

      Dr. Supten Sarbadhikari,  ‏@supten  Project Director at the Center for Health Informatics of the National Health Portal, stated his priority areas as, ‘National eHealth Strategy / Policy for India; Health Informatics as a formal discipline; Capacity building’

      Dr. Vikram Venkateswaran ‏@drvikram   Healthcare Influencer & Marketing Leader, stated his priority areas as, ‘reduce #infantmortality introduce  #universalcare increase #preventivecare.’

      Dr. Sunita Maheswari, Chief Dreamer, RxDx and Teleradiology Solutions, in a recent article in Deccan Herald, opined the growth of the Home Health Services such as medicines, pathology, nurse & physiotherapy visits. She also has indicated the need for more funding in other aspects of Digital Health services.

      Dr. Pankaj Gupta, @pankajguptadr, Founder Taurus Glocal Consulting, stated his top three areas to focus in 2016 as SMAC, IoT and CRM

      Dr. Aniruddha Malpani, MD Malpani Infertility Clinic , stated his top three priorities as, prescribing information therapy for patients, productivity solutions for doctors and Indian Language content

      Srikrishna Seshadri, Healthcare IT Consultant, stated his top three areas to focus as telemedicine, IoT and Digital Health Platforms

      Dr. Suresh Munuswamy, Assistant Professor, Program Coordinator, Indian Institute of Public Health- Hyderabad is an academic arm of Public Health Foundation of India

      1. Standards and Structure- For digital health care to even start, India needs standardized treatment schedules, standardized documentation (as EHR), standardized job roles, standardized continuous education and standardized social networking procedures for health care. Lack of standards and structure will lead to poorly inter operable and overlapping systems and procedures.
      2. Digital Health needs reliable supporting infrastructure ecosystem.
      3. Digital Health should focus on developing innovative, smarter, smaller and usable devices that can deliver quality health care…with lesser emphasis on (big or small) data analytics.
      I would like to thank all the experts for sharing their opinions.

      To provide an Integrated Digital Health experience the Hospital Providers need to enable agility in innovation, create the infrastructure to ease the interoperability of patient information, establish connectivity with the patient and continuously engage with the customer in the care continuum.

      Please share your views with me on LinkedIn or Twitter @msharmas or via email:

      The article was also featured on the February 2016 issue (pg.40-41) of Healthcare Radius


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      Founder, Digital Health Entrepreneur

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