Healthcare in most countries is either insurance-led (the USA) or state-led (the UK).

The best way to describe Healthcare in India is patient-led.

This results from a “khichdi” of healthcare options being available to patients, depending on their access, their capacity to pay and their unique belief system.

Nearly 50% of healthcare expenditure in India is still out of pocket.

While the Government and Public Sector Hospitals dominate as healthcare providers to the lower income classes, the middle- & upper-income classes tend to gravitate towards clinics, nursing homes and corporate hospitals.  To add to this khichdi, there is also the traditional medicine segment - Ayurveda and Homeopathy - nearly 7% of all outpatient visits are to traditional medicine doctors/ institutes.

With all this complexity, many patients particularly in urban areas, tend to flit back and forth between different hospitals and doctors – each time carrying back a written/ typed prescription.

This prescription is treated differently by different patients.

Take my father. A 70-year-old accountant, obsessed with data, who files everything. He has our medical records stored in files going back to 1980. If I were to search for my vaccination records from 1982, he would probably have these on file somewhere. Unfortunately, my dad makes up the miniscule minority of people who understand what Benjamin Franklin said,

“An investment in knowledge always pays the best interest.”

The majority of our country carefully guards their medical records, but only up until the medical emergency has passed. Post that, health records disappear into the ether, never to be found again.

Let me share with you an extreme real life story. A few years ago, I visited a village to see how healthcare was being delivered at the Primary Health Centre level. I even went to the home of a pregnant woman. She invited me in with gusto, saying she had a treat in store – they were making pakodas! It was only after I bit into my pakoda, that I saw the paper that it was served on – the middle sheet of her Antenatal Booklet.

In my thirties, having received medical care in the NHS, I was a huge proponent of the patient being the custodian of his own medical records. Having my data with me meant complete control over my medical records – being a doctor myself, I hated having to ask someone at the NHS for my data.

Being older and hopefully wiser means that I need to revise this view.

Studies claim that 35% of Indian Hospitals use medical records. The reality is far bleaker. To me, that number of 35% is vastly overstated – I’d bet that only 35% of doctors in these institutions (on average) would use EMR. And, to add to this, I’d say that these doctors call the same disease by different names, depending on their education and experience. In the 2% of cases when a record is actually transferred from one place to another to ensure continuity of care, a lot of vital information is lost, and that this impacts the quality of care.

The facts are these.

We need to have a registry of healthcare practitioners and institutions. We need to know if their licenses are valid, and that we aren’t being treated by quacks and compounders.

We need to ensure that a provider treating a patient has access to all aspects of her medical history. This means that when the patient “flits” from one provider to another, or when she seeks multidisciplinary care, her medical records are available in a standard, codified manner to each of these providers.

Every hospital needs to have a standard, codified EMR. Non-negotiable.

Our government needs to know if the right resources are available to the right patients.

Enter the Ayushman Bharat Digital Mission. Formed with the admirable idea of creating a health information superhighway, which ensures that all medical information of a patient is available, all providers are registered, and the ones who need care get care. A well thought out and far reaching idea.

While the government is taking steps in the right direction, the ABDM remains stilted in its execution, and shifts the burden onto healthcare IT companies and healthcare providers.

But that’s the subject of another rant.