Implementing Open Source Electronic Health Record (EHR) Systems for Hospitals in Developing and Underprivileged Areas

EHRs hold the promise of making it easier to capture, access and use health information for both patients and physicians. In practice, EHRs are failing to deliver this goal and present several challenges. Even with all the advancements in today’s information age, patients don’t have ready access to their health information. People with healthcare needs have to manually keep a record of their information and have to struggle to get their information from multiple healthcare providers that they may consult and get treatment from. Physicians on the other hand have to spend onerous amounts of time in recording EHRs. Studies have shown that physicians are spending as much as 50% of their time or more in recording EHRs, taking away valuable time they should be spending with patients. This is an extremely troubling trend as EHRs have been cited as the biggest cause for physician burnout, having the opposite impact of what we expect. And this is despite spending huge amounts of funding in implementing EHRs – the global expenditure for EHRs will cross $ 33.4 Billion by 2025. Only a few privileged nations across the world have the ability to spend that kind of money for an EHR ecosystem that is far from what is required, and the vast majority of the world cannot even afford this solution.

EHRs have almost universally been developed as provider centric systems that have been developed from the perspective of billing, claims and other enterprise processes for hospitals and healthcare providers, with the patient and physician perspective as an afterthought. These systems are simply not designed to empower patients and physicians. They provide limited access at best to patients to their own health information and face huge interoperability and usability challenges. Both patients and physicians struggle to consolidate and understand their health information spread across multiple providers, or even across different departments within a single hospital. They have to do this manually, and it’s a time consuming and error prone process.

Our own independent research with small to mid-sized hospitals and clinical practices in India indicates that most of them are either maintaining manual processes or implementing billing systems for medical billing of patients which do not maintain electronic health records. The privileged hospitals belonging to large healthcare provider chains are implementing EHRs, but these are once again siloed without interoperability, and these hospitals are too expensive for the majority of the population.

While Transform Global Health (TGH) is working on the Universal Health Information Network (UNHIN) with the goal to solve this problem globally, we want to start having an immediate impact on small to mid-sized hospitals and their patients. To achieve this, TGH is investing in providing enterprise strength EHR implementations to several hospitals in India and other developing and underprivileged regions for free. The system that TGH will provide these hospitals and clinical practices will help them with organizing their business and also maintaining EHRs for patients, and provide patients access to their records. This will be a service that is comparable to what the large, highly expensive hospitals are implementing.

This will have a profound impact on these hospitals and their patients, who will have EHRs comparable to large, highly funded hospitals, helping improve the quality of medical services that they receive. This helps TGH in benefiting patients and physicians in the very near term, providing early results, while helping analyze real world problem faced by these healthcare organizations that currently have no electronic systems or are relying on medical billing systems without EHRs.

Once the UNHIN is live, these small hospitals will connect to it, enabling a service level for their patients and physicians that exceeds what the largest, most highly funded hospitals are providing. Patients will have full access and control over their health information across all hospitals on the UNHIN. Their information will be secured to the maximum extent allowed by technology, meeting or exceeding prevalent standards such as HIPAA. Authorized physicians will be able to view the integrated medical record of a patient in a single place. Updates and notes from physicians will sync to the patient’s health wallet immediately, and patients and physicians will be able to engage more effectively, without putting any additional burden on physician time. It will in fact reduce the burden on physicians to research medical details, document treatment and test results, and provide updates to patients.

Find out more about this project at, and submit your hospital information if you feel you will benefit from implementing an enterprise grade HIS/EHR system.


1. EHR interoperability, connectivity a big challenge around globe new study finds:

2. EHRs get most blame for epidemic of physician burnout:

3. EHR use consuming physicians’ time for patients:

4. Global EHR Market to Hit $33B by 2025, Report Finds:

5. Global health workforce shortage to reach 12.9 million in coming decades:

6. 10. Top 10 Countries for EHR Adoption:

7. The Universal Health Information Network (UNHIN):

8. Open Source Hospital Information System (HIS) Implementation Project:


  1. Shubh Singh

    We have started work for two hospitals in India and are going to run some field trials at one of them next week. We’ll be sharing more details on the projects soon.

  2. Rose Rosenfeld

    When dealing with developing nations to implement electronic health records we got to pay attention to some ethical issues that may arise.

    One of the unique challenges is to provide the patients with information in a culturally and linguistically appropriate format. Informing people of methods to protect confidentiality and what will happen if there are data breaches may be a very different task in cultures that do not ascribe to a more western notion of individual privacy and personal autonomy. The same is true of any disclosures about research use, secondary use, data ownership, or any contemplated data sharing agreements and legal accountability.

  3. Teresa Fuchs

    The immense benefits of a patient’s doctors and hospitals being able to access and share health information cannot be overstated. It will be a great benefit not only to individual patients but to the community as well, and will lead to better health care for all.
    I was wondering though, in these developing nations, if the patients themselves have the available technology (computers, smart phones) to be able to access and manage their health information?