A quantitative approach to evaluating open-source EHR systems for Indian healthcare: a metadata perspective

Area of Science:

• Health Informatics
• Health Information Management
• Digital Health Standards

Background:

• Electronic Health Records (EHRs) standardization is crucial in India's diverse healthcare system.
• The Ministry of Health and Family Welfare introduced the EHR Minimum Data Set (EHRMDS) for uniform clinical documentation.
• Alignment of existing Open-Source EHR Systems (OS-EHRS) with EHRMDS requires thorough investigation.

Purpose of the Study:

• To quantitatively assess the metadata alignment between India's EHRMDS and various OS-EHRS.
• To introduce a novel quantitative benchmarking framework for EHR metadata alignment in the Indian context.
• To identify gaps and propose enhancements for the EHRMDS based on OS-EHRS.

Main Methods:

• A field-level, metadata-based quantitative assessment was performed.
• A structured crosswalk methodology combined syntactic similarity and ontology-supported semantic evaluation.
• A closeness percentage metric was developed to benchmark relative metadata alignment.

Main Results:

• OpenEMR demonstrated the highest metadata alignment with EHRMDS at 73.81%.
• OpenClinic exhibited the lowest alignment at 33.33%.
• 47 clinically relevant metadata elements were identified in OS-EHRS but missing from EHRMDS, forming an extended schema (EHRMDS-ext.).

Conclusions:

• The study provides a quantitative framework for evaluating EHR metadata alignment in India.
• Findings support the enhancement of EHRMDS with identified missing elements.
• The research lays groundwork for future interoperability studies in Indian healthcare.