Patients describe their symptoms to a family member, to a community health worker, to a faceless voice on helplines and digital assistants, to an emergency technician in an ambulance, to a nurse or a doctor in an outpatient or inpatient setting. Similarly, information from physical examination is elicited and recorded. These are captured in verbal, written, or digital formats. Current age digital technologies can translate verbal and written information into digital information. Smart algorithms can process the digital information into meaningful data. 

People and frontline health workers are able to monitor health information like blood pressure, temperature, heart rate, oxygen levels, weight, blood sugar etc., through various monitors and devices. The values are either recorded on paper or entered into health information management systems (HIMS). Direct transfer of data from the equipment to HIMS is currently possible through Bluetooth technology thereby eliminating additional human intervention. 

Additional health information is generated by performing biochemical, microbiological, and pathological investigations. Conventionally the reports are recorded on paper or entered into laboratory information management systems (LIMS). Majority of the testing equipment in current use can be directly integrated with LIMS to capture the results. 

Imaging technologies have revolutionized medical diagnosis. These are based on x-ray, gamma-ray, ultrasound, magnetic, optical imaging technologies. New age technologies capture the images in digital form. PACS solutions allow these images to be retrieved when needed. The reports are generated by the medical professionals based on their interpretation of the images and are recorded on paper or entered into HIMS. Artificial intelligence (AI) is being increasingly applied to interpret digital images and arrive at a diagnosis. 

Clinicians arrive at diagnoses that a patient is suffering from based on clinical and investigational assessment. The diagnoses are usually noted in their notes. Few clinicians do not commit any diagnosis when they are not sure of their diagnoses. Clinicians are highly reluctant to enter their notes into HIMS for variety of reasons. Similarly, they scribble their prescriptions in outpatient or inpatient records. Some of these prescriptions are the most difficult to decipher due to their handwriting styles. 

Under the work the Government of India is starting on the recently announced Ayushman Bharat Digital Mission, one of the core challenges likely to be faced will be in terms of ‘health data capture’ towards implementation research, solutions to challenges, and implementation support to the Center and the States. 

Health systems across the world ace the challenge of making clinicians enter the health information into HIMS. Legal regulations failed in most of the systems. Only the financial lever of payer systems seems to work across the systems. Hence, majority of electronic health record systems are designed for claims and not for clinical information. There must be alternate strategies to capture health information than that used by payer systems. 

Dr. Krishna Reddy Nallamalla

President, InOrder

Country Director, ACCESS Health International (India)

Photo Credits: VOGOVoice

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