Those were the early days at Lifetrenz. We were all very excited with our experiences and learnings in the US market. The excitement of building an Inpatient Electronic Health Records (EHR) product compliant to standards, seeing the product go through Meaningful Use (MU) certification and going live at Hospitals. It was no mean achievement for a Healthcare IT Startup based in Bangalore.
We then decided that we had to build an EHR solution that can address the needs of Healthcare providers in India. This country did not have a single standards compliant product then (not sure if there are true EHR standards compliant products available in market even today). However, we weren’t sure where to start with the Indian products. There were no official EHR standards for India then, unlike the US market. We had a number of discussions and debates, led by our CEO, Joe and Chief Medical officer Dr Pramod. After a number of brain storming sessions and pitchers of beer, we decided that the best bet is to adopt the leading standards for each of the major components of the EHR products that we were planning to build.
Thus we decided to adopt ICD 10 for Diagnosis, ICD 9 PCS for procedures, LOINC for Lab & Radiology tests, measurements & observations, HL 7 for messaging, DICOM for imaging, NIC/ NOC/ NANDA for Nursing and CCD/CDA for Continuity of Care Documentation. We also decided that the system should be built to adopt SNOMED CT standard, although India had not yet joined International Health Terminology Standards Development Organisation (IHTSDO – the organisation that owns SNOMED CT) as a member and there was no talk of it then.
In addition to the above standards, we had to take a call on the Drug Database that we were going to use in our products. We looked at some of the off the shelf Drug Databases that were available in India and weren’t very impressed with what we saw and concluded that it was best to build a Drug Database with Drug Information Framework on our own that would also provide Clinical Decision Support to physicians while ordering medications. We knew it would be a Herculean task building such a product and keeping it updated would be an ongoing effort. When we looked at the international scenario, we realised that there are a number of companies whose business is just providing such Drug Information Framework and Database. We still had to take that gamble if we were serious about our EHR products. We decided to go ahead and folks we can proudly say today that we have managed to build a Drug Database that contains all the generics as per Indian Pharmacopeia and more than 120,000 branded drugs sold in India (easily the largest Indian drug database), along with a Drug Information Framework that provides Clinical Decision Support for drug-drug, drug-allergy, drug-disease, duplicate therapy, dose-range, drug-food, pregnancy/lactation, geriatric, and pediatric precautions. The Database is compliant to the standard RxNorm. The Drug database and its CDS features are growing continuously to keep up with new drugs coming into the market.
Having taken the decisions around standards and Drug Database, the next question we had to answer was that which should be the first product we should build. We decided that we should first build an Ambulatory (Primary Care) product. We also realised that a pure play EHR product that does not cater to the Administrative, Financial & Operational needs of a provider will not be acceptable to the Indian providers unlike in the US market. In the US, the product we helped build was initially a pure EHR product and talked to other third party billing and other solutions to cater to the non-clinical functions (we later built an integrated financial solution for the US market also). So we went ahead and built our first product for the Indian Market – our Ambulatory product and took it to the market. We went on to build our other solutions – the PolyClinic/ Daycare Solution, Hospital Solution, Pharmacy Solution and the Diagnostic Center Solution – all complaint to international standards.
And then in August 2013, Ministry of Health & Family Welfare, Govt of India approved and published the Indian EHR Standards. To our surprise, the standards adopted by the Indian Government were the very same standards we had already implemented in our solutions. We didn’t have to make any major changes to make our products compliant to the Indian EHR Standards. Life went on and in March 2014 India joined IHTSDO and took a national license and made SNOMED CT available. Once again we had no major work to be done in our products to adopt this standard. We are proud to say that all our solutions have already adopted SNOMED CT and are the first solutions to do so in India.
In India adoption of these standards is still not mandated. However the Govt of India currently encourages all providers to adopt the EHR standards. Going forward the need to use Healthcare IT applications compliant to standards will become a necessity for the providers. However, world over such good solutions are costly and are not affordable by all providers. Having realised this, Lifetrenz has built world class products compliant to standards at affordable cost so that Healthcare Delivery Organisations in India can leverage IT to provide safer and quality healthcare to patients.
I am sure the readers would be eager to read about our experiences in taking these solutions to the Indian providers. Still interesting would be our learnings in implementing these solutions at some of the leading Healthcare providers. I shall share those experiences in my future blogs.