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REVIEW ARTICLE
Year : 2021  |  Volume : 65  |  Issue : 4  |  Page : 410-413  

The importance of the online storage of patient data in Indian COVID-19 scenario: A narrative review


1 Senior Resident, Department of Orthopaedics, AIIMS, Rishikesh, Uttarakhand, India
2 Junior Resident, Department of Orthopaedics, AIIMS, Rishikesh, Uttarakhand, India

Date of Submission14-Apr-2021
Date of Decision19-Aug-2021
Date of Acceptance14-Oct-2021
Date of Web Publication29-Dec-2021

Correspondence Address:
Aditya K S. Gowda
Department of Orthopaedics, AIIMS, Rishikesh - 249 201, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.ijph_1041_21

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   Abstract 


Generation Z has seen drastic changes in the medical sector with the health-care industry constantly updating itself with newer tools to provide quality treatment. The COVID-19 pandemic has greatly tested the services in every aspect of life and has led to an unprecedented increase in the online storage of patient data. Electronic health records (EHRs) are real-time records that make health information of any patient available securely to authorized users. EHRs in the Indian scenario are still in their budding stages, described as “islands of excellence in an ocean of inadequacy.” The central institutes and corporate hospitals have implemented it, but the state medical colleges and peripheral health centers have miles to go. These patient data records become an essential tool in physician's decision-making, expertise, and management. One can review the data which is just a click away even after the patients have been discharged, especially in the follow-up period. The current scenario is such that health-care workers and nonhealth-care workers alike share the data of the patients in respect to their records, radiographs, and laboratory data using social media such as WhatsApp, Facebook, and Telegram. In the absence of adequate regulations, the reliability of the EHRs is questionable and doubt creates a preference for the traditional medical services among the health-care workers. To conclude, a clear and precise guideline that can enlighten the patient and health-care workers is the need of the hour. The concerns of online storage of data need to be alleviated and privacy regulations need to be addressed.

Keywords: Electronic health records, modern technology, pandemic, privacy, social media


How to cite this article:
Raja BS, Watson T, S. Gowda AK, Jain A. The importance of the online storage of patient data in Indian COVID-19 scenario: A narrative review. Indian J Public Health 2021;65:410-3

How to cite this URL:
Raja BS, Watson T, S. Gowda AK, Jain A. The importance of the online storage of patient data in Indian COVID-19 scenario: A narrative review. Indian J Public Health [serial online] 2021 [cited 2022 Jan 22];65:410-3. Available from: https://www.ijph.in/text.asp?2021/65/4/410/333967




   Introduction Top


The past few decades have seen a tremendous increase in the quality of the services in the medical sector with the health-care industry constantly updating itself with newer and newer tools to provide quality service to the patients.[1] The pandemic COVID-19 has brought the world to its knees and has shown the differences in the health-care systems of developing and developed nations. India the nation with more than 1 billion inhabitants too has had a hard time battling the pandemic and indeed has done commendable work while facing significant hardships. With the Government's emphasis on the use of contactless transactions, documentation, in the Indian scenario, the COVID-19 pandemic has led to an unprecedented increase in online storage of patient data by health-care professionals (both governmental and private organizations).[2],[3]

The electronic health records (EHRs) have in large replaced patients' paper charts. These digital real-time records make health information of any patient available securely to authorized users.[4],[5] These are data, which contain the patient's medical history, the treatment he has undertaken, medications, laboratory results including radiological images. EHRs act as tools, which enable the providers to make decisions about patient, care and are built to share information with other health-care providers and organizations such as laboratories, specialists, medical imaging facilities, pharmacies, emergency facilities, and school and workplace clinics so much so that they contain information from all clinicians involved in a patient's care.[3],[4],[6],[7]

The EHRs in the Indian scenario are still in their budding stages. Although various institutes such as the central government institutes and corporate hospitals have implemented it, there is still a long way to go to implement these in the state-run medical colleges and hospitals along with the health centers spread throughout India.[6],[8] Moreover, the medical practitioners do tend to keep a copy of the records of the patient, especially in the private sector scenario with a notable thought into future litigations and medicolegal issues. However, with the medical practice being increasingly information sensitive and the need for protecting this highly sensitive health-care information in this era of technological advancements and cybersecurity threats, one must understand the whole process, the available tools, the guidelines, and the privacy and security issues.[3],[8],[9],[10] Although some steps have been initiated, several new steps need to be taken up for the successful adoption of EHR. It requires a coordinated multisectoral effort.[6]


   Rationale of Electronic Health Records Top


For understanding the rationale of EHRs, one should look at the past. In the earlier days, the records were physical copies or paper repositories of information wherein the patient and doctor or the hospital keep a copy in the medical record departments.[7] The loss of these copies from either party due to any issue may lead to an unprecedented situation, which can lead to the loss of valuable information. Moreover, with the medical practice becoming increasingly information sensitive and having to keep a track of a large quantity of data in physical form, it becomes cumbersome for the health-care authorities.[1],[4],[9] These records which comprise the patient data become an essential tool in physician's decision-making, their expertise, and information management. The physical records needed to be updated manually often resulting in subsequent delays in completion and difficulty in archiving.[2] The main limitation of such physical form of storage of patient's records was the lack of security it offered and the difficulty in tracking this information when one needs it. A higher resource requirement in the form of establishing medical record departments and large storage space for storing these copies for a long period leads to an increased toll on cash reserves.[6],[8],[9]

The EHRs help in this aspect. The purpose of these EHRs is to be a supportive tool for patient care. The clinical examination details, laboratory data, or diagnostic images are scanned or copied into the electronic system starting from the time of admission of the patient to the time of discharge. One can review the data even after the patient discharges, especially in the follow-up period with a click of the mouse to reveal all the prior details.[3],[4],[5],[6],[7] The data can be stored online and used by multiple health-care professionals if needed to perform as a real-time digital version of patient records. Over the long run, the EHRs help in accumulating a vast amount of data in the Indian scenario, which is useful as a platform for analysis of a larger data set for research.[3]


   Scenario in India Top


The expenditure on health services has seen an increase of 370% over the past decade, but the Government of India's (GOI) expenditure on health accounts for a meager 3.5% of its GDP which dwarfs in comparison to other developed and developing countries.[6],[11] Moreover, there has been a recent effort from Government's side to shift its role from provider to insurance in the health-care scenario. One such step seen was the supposed enrolment of the Aadhaar card as a health identifier for basic health services in the country in the year 2017.[12] Ayushman Bharat was introduced as a scheme to support 10 crore families with insurance cover in the 2018 Union budget. The budget also allocated approximately 3073 crores (INR) under the guidance of NITI Aayog, aiming to create a digital economy in health-care delivery with technologies such as artificial intelligence, the Internet of things (IoT), blockchain, and three-dimensional printing.[13],[14]

The use of EHRs in India is in its initial stages. The central government institutes such as All India Institute of Medical Sciences, Post Graduate Institute of Medical Education and Research, Chandigarh have started the use of these electronic records. The corporate sector too has invested in these EHRs with the majority of the corporate hospitals such as Fortis group, Max health-care group, Medanta, The Medcity, and Apollo hospitals have also started implementing these EHRs.[3] However, the bucks stop there. The majority of the country's state-run medical colleges still run-on records kept in physical form and it is even sad when one goes to the lower levels of medical care such as district hospitals/taluk hospitals/community centers and primary health centers where the electronic records if available are for billing and registration.[6]

Various recommendations and drafts have been released by Government for the betterment of EHRs in India. These include:

In 2006, GOI drafted the “Personal Data Privacy Bill” and placed it before the Parliament along with the amendments envisaged for ITA 2000. However, in 2008, the ITA amendments passed through but the Privacy Bill lapsed.

Electronic Health Record Standards for India: The MoHFW (The Ministry of Health and Family Welfare) in 2013 on recommendations from the EMR standards committee proposed the standards which was further revised and notified in 2016 and a revised version was later released on December 31, 2016 after taking feedback. It aims to make any person in India avail fully integrated and always available health records in an electronic format which is accessible in any health service provider/practitioner/any diagnostic center or pharmacy.[15],[16]

To ensure the development and promotion of the eHealth ecosystem in India for enhancing or enabling the organization, management, and provision of effective people-centered health services to all in an efficient, cost-effective, and transparent manner the National eHealth Authority (NeHA) was proposed to be set up by the GOI in 2015.

In addition, the function envisaged includes policy and promotion, standards development and release and maintenance, legal aspects including regulation, setting up electronic health exchanges for interoperability, capacity building, and certification framework of EHR products.[16]

MOHFW is setting up an Integrated Health Information Platform intending to enable the creation of standards-compliant EHRs of the citizens on a pan-India basis. It also aims to have better integration and interoperability of the EHRs through a comprehensive Health Information Exchange (HIE) as part of this centralized accessible platform. This platform enables better continuity of care, confidential health data/records management, and thereby accurate diagnosis of diseases and thus reducing patient re-visits and better affordability, optimal information exchange to support better health outcome, and thus eventually facilitating improvement in the reforms of treatment and care of public health at National Level.[17]

Digital Information Security in Healthcare Act was a draft put forward by MoHFW in 2018.[18] It aims to provide for the establishment of National and State eHealth Authorities and to regulate the processes related to collection and transmission of HIEs. The use of digital health data, to ensure reliability, data privacy, confidentiality, and security of digital health data and such other matters related and incidental are also noted in the draft.[16],[19]

In the current Indian scenario, the Government is also coming up with many schemes with one of the latest schemes being the Pradhan Mantri Gramin Digital Saksharata Abhiyan, wherein the scheme would empower the citizens in rural areas by training them to operate a computer or digital access devices such as tablets and smartphones), send and receive E-mails, browse the internet. This works as open access Government service provider, enabling people to use the Information Technology and related applications, especially Digital Payments to actively participate in the process of Nation building in the due process.[19] NITI Aayog 2018 proposed a visionary digital framework named “National Health Stack” intending to create digital health records for all the citizens of India by the year 2020.[20],[21]

Apart from the online storage of EHRs of the patients, there exists another scenario presently wherein health-care workers and nonhealth-care workers alike share the data of the patients in respect to their records, radiographs, and laboratory data among others using online platforms such as WhatsApp, Facebook, and Telegram.[7] The ease of communication made possible by such mediums has led to dependence. The patient privacy and the security of the documents while transfer of such data online are questionable. The Health Insurance Portability and Accountability Act (HIPAA) in the United States mentions that documents with patient details should not be circulated. The proposed Health Data Privacy and Security Act on the works by the Health and Family Welfare department of the Union Government is likely to draw a lot from the HIPAA of the USA.[22]


   Concerns Top


EHRs like all the other electronic services done online are susceptible to security breaches or hacking. There exists a scenario wherein the highly confidential documents are made public or extracted by unfair means. There should be reliability in the allocation of the access points for these EHRs as these can be altered or tampered with.[8],[9],[10],[22] There is concern and confusion regarding legal aspects of tracking patient location. At present, in the Indian scenario, there exists no health-care regulatory body. In the absence of adequate regulations, the reliability of the EHRs is questionable and the doubt creates a preference for the traditional medical strategies among the health-care workers.[6] The various health-care providers including the central government institutes and the private health-care institutes use different EHRs across different locations.[2] The sharing of the clinical data between the various stakeholders still seems to be a farfetched goal in India despite the GOI setting up standards for sharing health statistics. This is leading to low collaboration between the various stakeholders.


   Private Sector Scenario Top


The private sector set up in the Indian scenario is unique in that it caters to the majority of the population. A clear distinction is seen between the big corporates and the small-scale private setups and even providers that practice in rooms. This scenario can be described as “islands of excellence in an ocean of inadequacy.”[23] In reality, the EHRs are being used in select corporate hospitals with the smaller tier hospitals still using the physical copies. Moreover, these medical practitioners do tend to collect patient data and use it for research. Online storage of the patient data and its transfer through various platforms such as WhatsApp, YouTube, and Facebook do tend to occur. The need to secure patient privacy and rights is paramount which puts forward the need for regulations for these too.[3] With the recent privacy change by the app WhatsApp used by the majority of the medical practitioners for communication, there exists concern regarding the availability of the patient details to a third party. The government needs to put forward clear and precise guidelines which can direct the health-care worker and patients their rights and options that can be exercised.


   Road Ahead Top


For the betterment of the country and more than one billion inhabitants, the present scenario needs to be changed. There exists a need for stronger regulations.

The GOI needs to form a legal framework that should be imposed diligently and the laws should be formed in a participative manner, taking perspectives of health-care workers, their concerns into consideration along with accommodations for geographical conditions, resource availability, and public-private partnership administration model.[3]


   Budget for Emerging Technologies Top


The GOI should allot more to the health-care sector from the budget to focus more on emerging technologies. Moreover, the health-care providers should also need to allocate funds separately for the adoption of the newer technologies to cover the delivery of the resources and the logistics.[24]


   Framework for Adoption of Emerging Technologies Top


After allocating the needed budget for emerging technologies, the GOI should approach systematically to understand the lack of infrastructure in the country, the challenges that one can face while abruptly changing the systems and the need to tackle these challenges. It needs to define the use of the technologies and focus on designing a holistic solution that encompasses the laws prevailing and the need to monitor these regularly.[5],[16]


   Collection of Data Top


The use of the EHRs over a period will lead to the availability of a significant amount of data, which are specific to India. The data can be used in the future for the development of algorithms for artificial intelligence and research based on the Indian population.


   Conclusion Top


Electronic health record in the Indian scenario is in its budding stages. A clear and precise guideline that can enlighten the patient and the health-care workers is the need of the hour. The concerns of the EHRs and the online storage of data need to be alleviated and privacy concerns need to be addressed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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  In this article
    Abstract
   Introduction
    Rationale of Ele...
   Scenario in India
   Concerns
    Private Sector S...
   Road Ahead
    Budget for Emerg...
    Framework for Ad...
   Collection of Data
   Conclusion
    References

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