Health Systems for a New India: eObjects #Opensource Building Blocks

 

Here is a sequence of events over the last 8-10 years that lead to the #Opensource eObjects.

India has been majorly a paper-based Healthcare System. However, there have been pockets of success in transforming paper-based processes to electronic systems. Max Healthcare was one such initiative that took a leap of faith well before the rest of the market could even think in that direction. I happened to be part of that journey with an eclectic team that got dispersed at the end of the project but continued the journey in their individual capacities. Who could think then that such small individual efforts could come together later for the transformation of the country as a whole? It probably happens once in a lifetime. Serendipity positioned a very strong National leadership that could collate all these pieces together for building the National Digital Health Blueprint.

It all began when Max Healthcare partnered and outsourced its IT infrastructure support to Dell Services formerly Perot Systems in September 2009 for developing and maintain their IT operations across all Max Hospitals in India. This unique partnership provided significant value to Max in terms of enhancing the quality of services and reducing the treatment costs. While doing the transformation at max healthcare the team stumbled and fell and then learnt to walk again. For India the full implementation of EHR, Registries, Meta Data, Master Code Directories and Interoperability were seen first time in action here. Max Healthcare gave invaluable learnings of applying the global standards and architectures to Indian settings, something that had never been done before!

Looking at the successful transformation of Max Healthcare, Perotsystems was contacted by the Ministry of Health India to conduct current IT systems study in health sector in India and do the health checks. Due to merger of PerotSystems and Dell Services, Dell Services could not undertake the task. Later I picked-up that work and submitted the Public Health IT Study Report through Sector Innovation Council on Health, India. Since it was not possible to study every system being in use in a country like India, I and my team picked up the representative set that was diverse enough to extract critical findings that needed immediate attention. Later these findings and recommendations from the Public Health IT study became important part of Twelfth Five Year plan.

Setting up Meta Data and Data Standards was an initiative taken by the Ministry of Electronics and Information Technology under National e-Governance Plan (NeGP). It intended to promote the growth of e-Governance within the country by establishing interoperability across e-Governance applications for seamless sharing of data and services. Domain-specific committees were constituted under MDDS initiative. MDDS for Health Standards committee was one such initiative, which was constituted on September 2012 under the chairmanship of Joint Secretary MoHFW in pursuance of communication received from Secretary, Ministry of Electronics and Information Technology (MeitY).

Role of Meta Data and Data Standards in Primary and Public Healthcare
MDDS for Health Data Dictionary
Facility Registry: NIN HFI Project Report
National Digital Health Blueprint

eObjects were first written by Prof Dennis Streveler and Dr Pankaj Gupta in a white paper in Nov 2018 that was published by Niti Aayog in the book Health Systems for New India, Chapter 5 - Reimagining India's Digital Health Landscape Wiring the Indian Health Sector in Nov 2019.

ACCESS Health Digital Strategy Council defined the details of the NDHB building blocks - Minimum viable products including the eObjects and microservices architecture to comply with the NDHB Standards. ACCESS Health Digital runs a Social Entrepreneurship Accelerator to accelerate the implementation of the NDHB Standards through these building blocks.

The eObjects have now been adopted by Joint working Group of National Health Authority NHA and Insurance Regulatory Development Authority IRDAI Sub group on common IT infrastructure, in its report published on 11 Sep 2019 and will be built into the India’s national Health Claims platform.

The eObjects were designed for interoperability across the healthcare ecosystem on a federated architecture. eEncounter, eDischarge Summary Objects are for Provider-to-Provider interoperability; such that the data can flow across healthcare facilities, State HIE and National Data Lake. Whereas the eClaims Object creates a Financial Lever for the market. If the providers submit the claims in standard eClaims Object format then the turnaround time for their payments can be expected to be faster. Clearly eObjects are an innovative breakthrough.

This is very similar to what happened in the FinTech revolution in India where Government of India created the Unified Payment Interface UPI platform and then created the BHIM App and released the related Application Programming Interface APIs to the market. Later the Market used the API’s and built the hugely successful Paytm, Googlepay, Phonepe wallets. In 3 years the UPI transactions went from negligible to 1 Billion transactions per month.

Financial lever and strong governance for digital health transformation, plays a vital role in ensuring successful outcomes of such undertakings. India would do well to heed this truth.

My ACCESS Health Digital team got an eGovernance Award for the work.

The details of eObjects are published in #Opensource under MPL 2.0 #Opensourcesoftware license on OpenBodhik blog: www.openbodhik.in
FHIR based eObjects published in CSV/XML/JSON
Library of 1000 Data Elements and 140 Code Directories published in XSD
National Formulary of India - Generics Drug List Published in CSV
Healthcare Delivery Information System [HDIS] Minimum Viable Product [MVP] Definitions and Microservices Code Published

eObjects also published by ExpressHealth

eObjects referenced extensively by Nachiket Mor in his paper and book published by John Hopkins USA