Thursday, August 7, 2014

Immediate Need for the National eHealth Authority of India (NeHAI)

The National eHealth Authority of India (NeHAI) should be set up immediately to formulate the National eHealth Strategy (NeHS) for India and to initiate the necessary capacity building. It requires creating and sustaining multi-disciplinary teams of people with the right mix of clinical, technical, managerial and organizational skills. Sometimes engaging marketing experts and establishing a good service infrastructure to support eHealth services, e.g., to citizens, will be essential.
It should have the following:

Vision / Goals:
       To guide the adoption of e-Health solutions of national and state importance for India, and,
       To facilitate the implementation of e-Health by integrating and harmonizing the standards for health information exchange in India

It is often said that neither ICT applications, nor information by itself bring benefits. The gains can come from changes in processes or working practices that are more substantial than replacing paper with an electronic document, which may have been the trigger to benefit realization. 
For more complex eHealth investments, these multi-disciplinary teams should include people who themselves, have a multi-disciplinary background. Having completed the process, their extensive knowledge and expertise in this field have been enhanced by the experience.

Outcomes and Impact of eHealth:
  • Improved timeliness (better quality of healthcare delivery)
  • Effectiveness (right intervention / audit trails for adverse events)
  • Efficiency (less resources in terms of manpower, time and cost)
  • Informed patients and their caregivers
  • Better access

§Benefits of “asynchronous telehealth”:
§  Diagnostic accuracy,
§  Reduced waiting times,
§  Better referral management and
§  Greater satisfaction with services
§With the worldwide explosion in the use of mobile phones and mobile Internet, Behavioral changes needed foe benefitting health can be through
§  SMS-based services,
§  Live and asynchronous telemedicine, and
§  Interactive voice response  service (IVRS)

Reasons for Urgency and Alternatives:
  • The National Knowledge Commission (NKC) had recommended formation of National Health Information Authority (NHIA) in 2008. It has not been set up in these 6 years.
  • Currently DPR for Mission Mode Project (Health) is about to be finalized and that recommends formation of the Authority (NHIA / NeHAI). However, the National eHealth Strategy (NeHS) is yet to be formulated. Once NeHAI is in place, the NeHS can ensure smooth adoption of eHealth throughout the country by formulating a robust NeHS.
  • EHR Standards have been notified by MoHFW in September 2013 without any guiding NeHS from NeHAI. Therefore, lots of parallel non-interoperable eHealth activities are being undertaken in various states by both public and private healthcare providers.
  • MoHFW has paid for India to be a member country and has the national license of SNOMED-CT since April 2014. However, SNOMED-CT is yet to be available for free public access in India as a membership benefit. Initially CBHI was supposed to be the National Release Centre (NRC) for SNOMED-CT. Now C-DAC, Pune has been temporarily made the NRC till the time NeHAI is set up. The SNOMED-CT is still not publicly accessible.
  • Process for Cabinet note preparation for NeHAI (10 months’ timeline) has been started as it was in the Election Manifesto 2014 of BJP.                                      
  • To address the above points, 
  • Immediate Executive Order may be passed to set up NeHAI, or,
  • A post may be created for “Advisor to the PM for eHealth” to guide and expedite the whole process.


  1. Our country needs to expedite the process of constituting a national steering committee for eHealth and put in concerted effort towards a national eHealth policy. This was expressed to the ministerial representatives during the Regional High Level Meeting on e/m Health convened by World Health Organization (WHO) Regional Office for South-East Asia (SEARO) on 17 - 19 November 2013 at Bangkok, Thailand.

  2. Ministry of Health as already entered into MOU for use of ICT for dissemination of information to citizens. There should be effort to get information from citizens using SMS and mobile apps so that health events indicating possibility of epidemics of infectious diseases can be communicated to health department. There should be central repository of health information to which citizens and healthcare professionals should be able to send data with UID and all stakeholder should be able to retrieve past health data using UID of the patient. This will help to streamline immunization, antenatal visits of pregnant women, regular checkups of diabetic and heart patients and other suffering from chronic diseases. It is possible to detect, predict and prevent epidemics if data so gathered is analyzed using spatio-temporal details in geographical information system. It is also possible to reduce air pollution related diseases using air quality indices generated by department of meteorology, and acute exacerbation of asthma and COPD can be prevented. All this can be achieved by National eHealth Authority of India in a short span because many of above mentioned modules are readily available and need to be assembled in meaningful manner. The eHealth research and development is being done by several institutes and all these efforts need to be combined so that optimum results are achieved using funds already spent on various projects.

  3. this should include, when patient got admitted for current problems, treatment given, discharged, referred etc from PHC level onwards. so we know what out medical officers are doing.

  4. It is need of time. Indian government should think and take immediate action in this regard.

  5. I support this suggestion by Prof Supten.

  6. I think the points made by Dr. Supten are on target. It is apparent that we confront the same problems year after year, like a festering would that never seems to heal. A clear plan of action with well demarcated areas of responsibility and activity, which allows available resources to be optimized for cost-effective attainment of superior outcomes can do a great deal to address the current lacunae. Hopefully the new government which has projected an aura of decisiveness can convert the "talk" of the preceding years into "action"!

  7. It is interesting and daunting at the same time....i really got the thrust of the blog as a need/ domain/ prospect of e-Health in the country.
    Sir, the concept of neurocognition /system gain / pattern recognition are frontier fields even in the "developed"(so called) world. with the experience of filling the vaccum in our country , which itself is humungous....i would suggest that the mandate of / for the government should be a regional / continental / SE asia or global hub of e-Health governance.
    The domain of conventional health care ,with all its shortcomings, would be initially complemented and probably dominated by e-Health delivery (both provision and seeking ) services in the long run , even in Systematic care naive / deprived areas of our country!
    There definitely is experience / initiatives available both within and outside the country in this regard....!

  8. i missed out on the content in terms of SNODEN-CT/ DPR / CDAC etc - sorry for the naivette....but i surmised that they would be intersectoral / disciplinary!. nowhere in our health care delivery system (substantial as that is) do we have medical experts as experts in e-health governance as there definitely a vaccum in this regard. what i am suggesting is that , there is a global our aspirations , at the policy ,aker level, could be to a global leader or a regional leader amongst our resources ( we are the richest in uman ailments of all kinds both in quality and in quantity) are huge!!!

  9. just found this as interesting -
    from Society of Physician Entrepreneurs (SoPE):-
    Does your organization have an eCare Center?

    Arlen M. President and CEO, Society of Physician Entrepreneurs Top Contributor
    As payment moves to value-based models, telemedicine could become an important part of the hospital’s financial future. One health system is already planning on the financial benefits by creating a standalone virtual medical center.

  10. I consider Prof. Sarbadhikari's suggestion to be spot on, especially at a time when eGovenance is much talked of. Besides the NKC, the National Institute for Smart Government's (NISG) core scope document for the MoHFW strongly recommended a unified eHealth architecture and eHealth roadmap for the country. These suggestions were released mid-2013. India needs a single organisation that can be the champion or steward of eHealth in the country. Failing this, India's eHealth landscape will become further fragmented, which will negate to a great extent the very promise of eHealth.