EHR Debate

In India a political debate is developing from publication of an IT vision paper,"Transforming Bharat" (India is called Bharat in Hindi), by an opposition party - the Bharatiya Janata Party (BJP). (See a post by Indrajit Basu: Digital Community Innovations from around the World - India's Opposition Party Promises IT Nirvana for All - for discussion of the Indian context.)

An excerpt:

The BJP’s IT Vision will help India (a) overcome the current economic crisis; (b) create productive
employment opportunities on a large scale; (c) accelerate human development through vastly
improved and expanded education and healthcare services; (d) check corruption and (e) make
India’s national security more robust.

Some highlights of this IT Vision are (page 2):

@ Multipurpose National Identity Card with Citizen Identification Number (CIN) in 3 years; to replace all other identification systems.
@ 1 crore students to get laptop computers at Rs 10,000. Interest-free loan for anyone unable to afford it.
@ All schools and colleges to have internet-enabled education.
@ National Mission for Promotion of IT in Indian Languages.
@ Broadband Internet in every town and village, with unlimited upload and download data transfer limits, at cable TV prices.
@ Mobile penetration to be raised in five years from 40 crore to 100 crore subscribers.

@ 100% financial inclusion through Bank accounts, with eBanking facilities, for all Indian citizens. Direct transfer of welfare funds.

@ A basic health insurance scheme for every citizen, using the IT platform. Cash-less hospitalisation.
@ All PHCs to be connected to a National Telemedicine Service Network.
@ National eGovernance Plan to cover every Government office from the Centre to the
Panchayats. The ‘E-Gram Vishwa Gram’ scheme in Gujarat to be implemented nationwide.

Regarding ehealth (page 24) the BJP promises that every hospital and primary health care center (PHC) in rural areas would be connected to a National Telemedicine Service Network, every citizen would have an electronic health record and universal health care would be offered through a basic health insurance program using the IT platform. Service to rural areas would be improved through IT-enabled mobile diagnostic vans and health care work force training programs.

Distinctive features of this Indian vision include the commitment to universal health care with a unique citizen identifier, and integration of government (including health care and education) and financial services through public telecommunications infrastructures.

This Indian example shows how the EHR may be effectively viewed in the broader context of a national IT platform. Patient identification is a fundamental issue which also needs to be addressed in U.S. policy before EHR implementation can be meaningfully promoted through economic stimulus or other measures.