April 2011

Accessibility – any time, anywhere

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Easy accessibility, improved clinical decision, reduced costs, increased hospital process efficiency —electronic medical records offers it all

By Dhirendra Pratap Singh

The Indian healthcare market is currently estimated at US $35 billion and is expected to reach over US $75 billion by 2012 and US $150 billion by 2017. According to the Investment Commission of India, the healthcare sector has experienced phenomenal growth of 12 percent per annum in the last 4 years. Rising income levels and a growing elderly population are key factors driving this growth.

The increasing demand for quality care with rising competition has made hospitals maximise utilisation of technology in driving processes and streamlining operations. Not only corporate, but also stand-alone small and mid-size hospitals have woken up to the adoption of hospital information systems (HIS) making it an integral part of hospital management. Similarly, electronic medical records (EMR) and electronic health records (EHR) are making their way into the hospitals, albeit at a slow pace.

While both EHR and EMR refer electronic version of records, EMR is limited to a specific institution or a group of institutions, while EHR relates to a common platform that would allow disparate institutions in the private and government sector to share medical charts electronically (within strict guidelines for maintaining privacy of patient records). The whole idea behind the EHR philosophy is to allow the chart to be portable between hospitals allowing greater flexibility for patients and doctors.

Joseph Puthooram, Managing Director, Edgeware Technologies says, “A quantum leap from the EMR is the EHR. When a patient’s electronic clinical record exists across disparate institutions, either vertically from primary care through secondary and tertiary care or horizontally across geographic boundaries, we achieve the EHR. In fact the paper record’s biggest weakness is its inability to be available at multiple locations at the same time.”

He adds, “Without the EHR, even telemedicine is crippled, having hardware without the supporting software, and its absence is a major cause of telemedicine’s ineffectiveness! When one is looking at the health of the nation, the transparency, access, quality, control of costs and a host of previously unimaginable benefits, including preventive care, can accrue with the implementation of the EHR.”

Sajal Kumar Agarwal, Managing Director, bbnisys Technologies says, “Indian healthcare is experiencing a transformation, with the commencement of newer, better IT applications with secured technology. With increasing IT applications and insurance penetration, the demand for EMR is anticipated to increase robustly in next few years.”

Pre-requisites

When introducing EMR to the hospital environment, it is critical to establish an HIS, prepare and involve various stakeholders (internal and external), and define a clear implementation path for EMR. All components of EMR must be compliant to integrate with other existing information systems in the hospital. Dr Ashish Dhawad, Founder and CEO, Medsynaptic says, “Today systems like HIS/EMR have become a necessary tool to provide quality healthcare to patients.”

 

Benefits

An EMR system must capture the entire patient data on a fixed format at the point-of-care. It should ideally be using a database, rules engine and knowledge base as the primary source of information; it should allow software integration of the EMR data with other data such as billing, practice management, laboratory, imaging and pharmacy systems. This saves time for the clinician by reducing double data entry in the other systems, while also ensuring the quality of data throughout the entire system.

A good EMR system has the capability of providing clinical decision support (CDS), helping in developing and implementing a provider’s decision making. Since, the capture of clinical and demographic data is in a pre-determined format, it allows several clinical attributes to the data processing like, clinical decision-making by accessing a rules engine to provide alerts, reminders, clinical protocols, coding assistance.

Further, since the system integrates with other components of hospital information and management systems like lab, pharmacy and imaging, it can provide real-time data to the provider in its entirety, right from symptomatology, signs and investigations, thereby facilitating better clinical decision-making.  It also allows access to large amounts of data quickly, permitting to analyse and report data quickly and easily, including clinical statistics analysis, population health, and other reports.

The EHR maintained by an individual to have better control of his own care is known as a personal health record (PHR). It is an electronic, cumulative record of health-related information on an individual, drawn from multiple sources that is created, gathered, and managed by the individual. A PHR should include cumulative health information ranging from past and current illnesses, demographics, allergies, prescriptions and more.

Challenges

At present, only a miniscule portion of doctors are enthusiastic about embracing this technology. Given the volume of patients they see in a day, it is hard to imagine physicians taking time to make notes directly into the system.

There are several software packages currently available in the Indian market that offer EMR along with HIS, but unfortunately, there are only few takers for the EMR. Unless there is a serious effort at educating the medical community in India about benefits of an electronic system, we will miss out on this marvelous revolution. Selling HIS or EMR packages to hospitals should not be the goal but a by-product. Software companies should first invest time and effort to educate the customer. Then they need to sell the appropriate package if it is the right fit.

Joseph Puthooram says, “The EHR seems a distant reality in India today. But there is the silver lining of VistA, the multi-billion dollar EHR system that is available free under the US Government Freedom of Information Act. With its implementation at the AIIMS Trauma Center, Rajiv Gandhi Cancer Institute and the Max group of Hospitals, it is a technology that can potentially enable India leapfrog in promoting the Healthcare of this great nation.”

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