Electronic Medical Records FAQ

1) What is EMR?

By definition, an Electronic Medical Record (EMR) is a digital version of a patient’s clinical history from a SINGLE facility.

The web EMR, a reference application provided by NDHM, is a light weight, easy to use application with sufficient functions to capture important clinical details about the patient’s care in a facility.

It is to be noted that this application does not provide advanced features like Clinical decision support (CDS), Computerized Physician Order Entry (CPOE), Clinical Pathways etc.

2) How does the EMR work in the context of the NDHM?

EMR would act as the primary source of clinical information for the patients registered in your facility, if you have registered as a HIP. The patient’s clinical information will be linked to their Health ID. The clinical information can further be shared with other Healthcare facilities after the patient provides consent. The patient can provide consent to share specific records or all records from a specific facility, with other entities of the health ecosystem, like doctors, facility providers, wellness centres, insurance companies and TPA’s.

3) How will the EMR help in recording clinical information for patient?

National Digital Health Mission has identified 5 clinical documents that is captured as part of any patient’s clinical encounter with the facility. The number of documents recorded will depend upon the type of encounter. The clinical documents that are available for capture are:

  • Diagnostic Report for Laboratory
  • Diagnostic Report for Imaging\ Radiology
  • Doctor Prescription
  • Outpatient Department Consultation Notes
  • Patient Discharge Summary

No specific intelligence is built into EMR to restrict which documents are recorded for a particular visit type and the user will make the choice based on the different scenarios.

* Prescriptions in the EMR application only support OPD and Take-Home Medication for discharged Inpatients. Inpatient Prescription is not handled in this version.

4) Where will the clinical information be stored?

A large hospital or a public health program (like RCH) could hold the records of patients in long term storage on premises or in the cloud as per its own policies.

Smaller diagnostic centers / clinics may use a specialized health repository provider who provides software solutions to help issue documents to patients and hold the same in long term storage.

5) How can I see the clinical history of a patient recorded in my facility?

EMR application has a built-in clinical history viewer where doctors can view clinical history recorded within the facility. The clinical history will include all or some of the 5 documents mentioned in point 3 above, as prescribed by NDHM. However, this information will be available across all the encounters that the patient had with the registered facility.

6) How can I see clinical history of a patient recorded in other facilities that the patient has visited in the past?

The EMR application also has a viewer for viewing clinical records for a patient that were recorded outside your facility. The clinical information can be viewed in a HTML format in a “read only mode”.

The duration for a read only operation will be governed by the consent accorded/given by the patient and can be revoked at any point of time, in the read only time slot.

7) Can I store radiology images of patients that has been performed outside of my facility?

The EMR web application only allows to store a PDF/ JEPG/PNG type of document which would ideally be the clinical interpretation of a radiology procedure. Every upload will represent one individual Radiology procedure. There is provision to attach more than one document to a Diagnostic report be it Lab or Imaging. The only limiting conditions are that each file should not be more than 500 MB and should only be in PDF/JPEG/PNG formats.

Note: The Diagnostic report or laboratory also follows the same design.

8) How is the security of data going to be ensured?

The EMR application is highly secure and makes use of several inbuilt industry leading security mechanisms that encrypt entered information before transmission and receipt. Furthermore, no information is shared without explicit consent of the information owner (Patient).

9) What should I do if I need more functionalities that are not currently available in the EMR?

The NDHM framework is, based on open standards and interoperable with most of the solutions available in the market. It also supports the following major health data standards:

  • FHIR Release 4 - For Interoperability and Data exchange.
  • SNOMED-CT – For codifications of Clinical records
  • ICD-10 (and future updates) – For codification of conditions/ Diagnosis
  • LOINC Standards – For codifications of Lab and Radiology procedures.
  • EHR Standards (2016)

In case specific additional functionality is sought, they can be added by contact the technical team at NHA for support and interoperability requirements.

10) Will I still be a part of the NDHM initiative if I use an EMR other than the one provided? And if so, how can I share clinical information with the Patient.

Healthcare facilities are more than welcome to use proprietary EMR solutions as long as the following conditions are satisfied:

• Health care facility is registered as a HIP (Health Information Provider) with the Facility Registry.

• • Proprietary EMR solution needs to conform to Health Data Interchange specifications as specified by NDHM. The Health Data Interchange guidelines can be referred to here https:\\nrces.in\ndhm

•The proprietary EMR needs to be able to link with the Health ID portal to generate Health IDs for patients without a Health ID or to validate Health IDs of patients. For more information on how your software vendor can become compliant you could ask them to review the documentation on the NDHM sandbox and register to be able to test their application on the sandbox environment. The sandbox environment can be accessed here https://sandbox.ndhm.gov.in

11) What are the Health data standards being used?

NDHM has proposed to use the following Health Data standards:

  • FHIR Release 4 - For Interoperability and Data exchange
  • SNOMED-CT – For codifications of Clinical records
  • ICD-10 (and future updates) – For codification of conditions/ Diagnosis
  • LOINC Standards – For codifications of Lab and Radiology procedures.
  • EHR Standards (2016)

12) Can I record clinical information if I am not comfortable using the Health Data standards prescribed by NDHM?

During the initial phase of launch, NDHM is offering flexibility to facilities, to record data in a text format, so that digital records can be easily maintained. In addition, NDHM also provides tools to search and lookup functions for medical terminology, that also assist users to quickly and efficiently achieve complete compliance to specific standards.

13) Can I edit clinical information that has been created by me at a later point of time?

Data once submitted cannot be updated or deleted. This is as per the nonrepudiation policy adopted by NDHM,

14) What do I need to do to share clinical data with the patient?

A patient’s clinical records will be automatically linked to their Health ID at the time of registration at a facility. Patients can search and view their records in a given facility, where they have an encounter registered, using a Personal Health Record application.

15) I want to create / edit my credentials. What is the procedure for the same?

User ID’s for doctors and facilities will be stored in the DigiDoctor and the Facility Health Registry respectively. Please click on the link below or contact the NDHM helpline.

Link for FAQ of DigiDoctor: https://doctor.ndhm.gov.in

Link for FAQ of Health Facility Registry: https://facility.ndhm.gov.in

Link for FAQ of Health ID: https://healthid.ndhm.gov.in

NDHM Helpline Options: Toll Free Number (24/7): (1800-111-4477))

16) I am having issues with the application whom do I need to contact?

Please contact the NDHM help desk. You can choose any of the following options to contact

Toll Free Number (24/7):(1800-11-4477 / 14477)