Healthcare is an ecosystem that works based on the interplay of a large number of stakeholders.This is in sharp contrast to other systems eg.banking and finance, which are mostly template based and transactional in nature. This makes Healthcarean information-intensive industry that relies heavily on collection, dissemination, interpretation, and monitoring of timely, accurate and authentic data.

The information systems within India’s health system have been known to have existed in silos recording, documenting and analysing data, indifferent to each other. Data is so diverse or incoherent, that inferring substantial meaning from the collected data is difficult. The information recorded at various stages of health system lacks quality, traceability and conformance to any common standards. The use of technology in healthcare has been isolated and the gains from its use have been sub-optimal, owing to varying degrees of partial implementation in the country at district or state level. The system is highly fragmented and lacks the concept of ‘interoperability’ on various levels.

The Healthcare sector is flooded with Healthcare-IT applications designed and developed on a localised need basis, without any thought for incorporation of any standards. Each application was developed for standalone use without anticipating the need for interoperability at a semantic level. Systems were never designed to talk to each other due to a lack of appreciation for the EcoSystem characteristic of the Healthcare Industry. Even if technical and organizational interoperability are achieved, semantic interoperability invariably remained a challenge.

For example – all applications must have the same Facility master. When Application A sends the ANC data for Facility 123, the receiving Application B should understand ANC and uniquely identify Facility 123. Another example is if a hospital application sends the insurance reimbursement bill to the insurance company/government, the recipient application should be able to understand and re-present the same meaning of billing information.  This results in poor care experience for the patient while also causing financial hardship to the provider. The problems get magnified in the context of universal healthcare, where another important stakeholder, the payor needs to participate in this ecosystem.

Interoperability among e-Governance applications for the health sector requires exchange of information across a variety of purpose built applications. There is a need for commonly accepted data definitions for the various data elements used in e-Governance systems in Healthcare. Standardization of data elements is a clear prerequisite for systematic development of e-Governance applications in the health sector.

The old HIS and EMR systems or even the new breed Digital Health Apps have so far lacked credible use of Global Digital Health Standards. Hence, they exist in silos and are unable interact with each other to support the processed of the larger Healthcare ecosystem. Moreover, the data available, cannot be used for any meaningful analysis.

To help the systems communicate with each other and equip them with the paramount concept of interoperability ‘Electronic Objects’ (eObjects) were designed, eObjects were first conceptualized and written by Prof Dennis Streveler and Dr Pankaj Gupta in a white paper in November 2018 that was published by the NITI Aayog in their book “Health systems for New India”, chapter 5-‘Reimagining India’s Digital Health Landscape wiring the Indian Health Sector in November 2019’.

The Strategy Council at Access Health Digital, defined the details of the building blocks- Minimum viable products (MVPs): eObjects and microservices architecture to comply with the National Digital Health Blueprint (NDHB) standards.

The eObjects were designed to impart interoperability across the healthcare system with a federated architecture and siloed systems. ‘eEncounter’, ‘eDischarge Summary’ objects ensure provider -to-provider interoperability; such that the data cam seamlessly flow across healthcare facilities, State Health Information Exchanges (HIE) and into the National Data Lake. Whereas, the ‘eClaim Object’ is designed to speed up  financial flows between them. If the providers submit the claims in standard eClaims Object format then the turnaround time for their payments can be expected to be faster. Clearly eObjects are an innovative breakthrough for comprehensive interoperability in an interdependent work environment, in order to make Universal Healthcare a reality.

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