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Exclusive: Inside Telangana’s pilot project to digitise the health records of citizens

Read the finer details of the state government’s plan that is in line with the recent push for digitisation of healthcare in India.

You are reading it here first: A pilot project to generate and facilitate the sharing of electronic health records (EHRs) of residents will be conducted in two districts of Telangana, according to a tender released by the state government’s Health and Family Welfare (HFW) department. The tender proposes to digitise health records of approximately 3 lakh adults living in the Rajanna Siricilla and Mulug districts, and collect data like their bloodwork, demographics, weight, height, etc.

Additionally, a health data analytics platform is also mentioned in the tender. If successful, the pilot will be expanded to all districts of Telangana for which a fresh tender will be issued.

After the launch of the central government’s Ayushman Bharat Digital Mission (ABDM), multiple state health digitisation projects have popped up. Such projects need to have adequate safeguards in place as health data is sensitive and may lead to distress and discrimination if mishandled by third parties or government authorities themselves.

What data will be collected?

Data will be collected through a door-to-door survey by ASHA workers, auxilliary male nurses, anganwadi workers, etc. It will include:

  • Demographic data from the Village Health Records. The tender said that this should be identified using district, mandal, village, mobile, and Aadhaar numbers. According to the tender, the state health department is maintaining VHRs in the two districts which have to be linked to the EHRs. However these records will have to remain editable.
  • Blood sample will be collected to find out the blood group from a government diagnostic centre. The results will be integrated with EHRs.
  • 10 to 12 questions on ‘basic health parameters’. The tender does not mention what exactly are these parameters.
  • Weight, height, blood pressure, pulse rate, etc., will be recorded.

How will this data be stored?

According to the tender, the data will be stored on the application made by the EHR service provider i.e. the private company that is awarded the tender, which will be hosted on the State’s data centre. A healthcard will also be issued to individuals whose data has been collected.

The app is required to provide the following functionalities for data storage and management:

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  • Identify and maintain patient records through a Master Patient Index (MPI) where user records will be connected to their Aadhaar or, in the absence of such an identity document issued or acquired by the citizen, another ID card may be used. It lists the following requirements for MPI:
    • Should be able to add or remove attributes
    • Should support matching technology to check transcription errors
    • Should provide a tool for bulk matching of duplicate records which can be manually merged
  • EHRs made on the app should cover information from clinical encounters, diagnosis, medications, pathology, and X-Ray related information
  • Include preventive health features
  • Have a feature for referral creation
  • The app should also conduct provider profiling (it does not mention if this is a health service provider) and quality analysis of the health data
  • The EHR system should be platform independent, should work offline and online, and be compatible across desktops, laptops, mobile, and tablets

Security requirements for the system

  • Retention: The tender said that all data in the system has be retained for seven years, extensions for which will be decided by the HFW department.
  • Detecting vulnerabilities: The app and system provided for the pilot project should be able to prevent or stop an attack in case of unauthorised access.
  • Standards-based encryption, audit, etc: Standards-based encryption (in transit and at rest) for all data, standards-based audit and logging capabilities; standards-based sensitivity and flagging mechanisms should also be part of the app and systems.

How will health records be shared?

Aadhaar authentication of doctors in PHC/CHC/District Hospitals or other authorised places shall be done through biometric scans or OTP before allowing access to patient health data, the tender read. It also said that citizen consent will be required before sharing the records, although it doesn’t mention how consent has to be obtained. The tender further asked for the following features to be put in place in the app and IT system for the pilot project:

  • Custom Application Program Interfaces (APIs) which allow different systems to be linked should be developed.
  • Standards put in place like the HL7 by the National Health Authority should be followed. Along with this, there should also be certain standard for meta data.
  • Village Health Records should be used to manage the entities part of the system, and keep record of all transactions that take place in the EHR.
  • Should be able to integrate with existing health applications of Telangana as well as point of care and IoT devices. Further, it should allow exchange of data with existing and prospective systems of the government.

Aggregated health data from citizens should be:

  • Based on different indicators, as charts or tables, as well as map based analytics
  • Presented as a customised or standard report

To view these reports, the tender required that there be ‘role-based dashboards’.

A portal to provide reminders for patient care, access to records

The tender also required that a portal for patients, doctors, and a National Identification Number (NIN) portal for health facilities be created. They are expected to have the following features:

  • Issue alerts for specific patient care and give notifications to treating physician or health program manager about unusual patterns of diseases for their upcoming appointments
  • Communicate patient data to the physician
  • Data security and privacy should be ensured in accordance with the Ministry of Health and Family Welfare’s guidelines
  • Provide role-based access to users
  • Be able to mask some data which a patient may not want to share with the data
  • Accessible on all common browsers
  • Comply with the ABDM (The tender does not elaborate further on how or what this compliance would entail)
  • Should adhere to guidelines for government websites issued by the central government and have periodic functional tests and security audit

How will the project be governed?

The HFW department, along with experts from IIIT, will constitute a committee to steer and monitor the project.

  • A department coordinator will be appointed by the HFW department
  • The list of users who should be provided credentials will be given by the department
  • Give guidance to the service provider
  • Hardware, software, licenses, SMS gateway required will be provided by the department

ABDM and other health digitisation missions

After the start of the Ayushman Bharat Digital Mission in August last year, the following state governments announced projects to issue Health IDs and digitise health records of citizens.

Uttarakhand: In December 2021, the Uttarakhand government digitised health records and issued health IDs to 10,000 people in partnership with health tech startup eHealth Systems.

Delhi: In October 2021, the Delhi cabinet gave financial approval to the government’s eHealth card and Health Information Management System (HIMS) project.

Tamil Nadu: In September 2021, the state’s health minister Ma Subramaniam announced that the government would assign Unique Health IDs to each of its citizens.

Bihar: In September 2021, the state began a health digitisation project in its Nalanda district in partnership with eHealth Systems.

Odisha: In August 2021, the state government started a health digitisation project related to mother and child in various districts.

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Written By

I cover health technology for MediaNama but, really, love all things tech policy. Always willing to chat with a reader! Reach me at anushka@medianama.com

MediaNama’s mission is to help build a digital ecosystem which is open, fair, global and competitive.

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