The rigmarole ofÂ carrying pile of medicalÂ reports is no longerÂ being practiced inÂ modern healthcare,Â welcome to the worldÂ of Electronic HealthÂ Records (EHR)
By Sharmila Das, ENN
During our visits to doctorâsÂ clinic or hospitals we oftenÂ come across people waitingÂ with their medical reports.Â While this practice has been in placeÂ still now, many hospitals and privateÂ clinics have started getting benefitsÂ of using EHR. An EHR is an IT enabledÂ solution that keeps ones medicalÂ records saved in computer for furtherÂ reference. It is a digital and portableÂ version of the current paper file systemÂ that would be accessible to allÂ doctors. That means that wheneverÂ you see a new physician, you couldÂ stop filling out endless paper forms,Â as your doctor could access everythingÂ about you on the computer.
Sumanth Tarigopula, VP, AppsÂ Global Delivery India, EnterpriseÂ Services, HP shares, âAn EHR is systematicÂ collection of electronic healthÂ information about individual patientsÂ or populations. Patientsâ treatmentÂ often happen at multiple locationsÂ like initial investigation with a primaryÂ care provider, lab tests with aÂ lab provider and pharmacy intakeÂ with the pharma providers. Due toÂ this distributed care the care recordsÂ are stored in multiple systems or asÂ paper records resulting in limited accessÂ to the records Â when a providerÂ has to review past records to provideÂ treatmentâ.
A recent study says an accountabilityÂ tool embedded in an EHR systemÂ could help reduce unnecessaryÂ CT scans among emergency Â departmentÂ patients with abdominal pain.
Arup Mukherjee, COO, BinaryÂ Spectrum says, âAlthough EMR hasÂ tangible positive outcomes, the adoptionÂ rate of EMR/EHR/PHR in IndiaÂ has been low so far. The marketÂ comprises handful of hospitals usingÂ EMR but the usage of EMR is mainlyÂ limited to corporate hospitals in theÂ various metro cities of India. SeveralÂ large hospitals in India have announcedÂ extensive expansion plansÂ during Â 012-2015 in response to theÂ increasing healthcare needs of theÂ countryâs growing population. ResearchÂ firm projects that the hospitalÂ services market, which representsÂ one of the most important segmentsÂ of the Indian healthcare industry, isÂ expected to grow at a compoundedÂ annual growth rate of 15 percent forÂ the period of 2010-2014 and thus beingÂ worth USD 81.2 billion by 2015.Â Further, the healthcare segment offers an attractive growth opportunityÂ for the information technology (IT)Â and business processing outsourcingÂ (BPO) industry.
âAn EHR is systematic collection ofÂ electronic health information aboutÂ individual patients or populations. PatientsâÂ treatment often happen at multipleÂ locations like initial investigation with aÂ primary care provider, lab tests with a labÂ provider and pharmacy intake with theÂ pharma providersâ
Sumanth Tarigopula, VP, Apps Global Delivery India, EnterpriseÂ Services, HP
Bhavesh Thakker, VP, Chowgule Â Mediconsult Pvt Ltd says, âThe marketÂ for EHR â which covers both Â EMR andÂ PHR – may be relatively smaller as comparedÂ to the developed markets, but theÂ growth rate demonstrated in the lastÂ few years is very encouraging. EvenÂ more encouraging is the positive outlookÂ shown by most healthcare providers onÂ the need to integrate these as standardÂ industry best practice criteriaâ.
Dr Suresh Munuswamy, Faculty forÂ Health Informatics, Senior Lecturer,Indian Institute of Public Health, Hyderabad,Â Public Health Foundation ofÂ India says, âThe state or perhaps theÂ centre has to take the lead, in developingÂ a central EHR back bone and enableÂ or incentivise private healthcareÂ facilities to set up infrastructure toÂ link up to the central EHR. FacilitiesÂ which are receiving state insuranceÂ payments could be the starting point.Â An example would be the MedicareÂ EHR Incentive Program in USA providesÂ incentive payments to eligibleÂ professionals, eligible hospitals, andÂ CAHs that demonstrate meaningfulÂ use of certified EHR technology. ProjectsÂ like AADHAR card and NationalÂ Optical Fiber Network (NOFN) wouldÂ need to be greatly leveraged to makeÂ EHR, EMR & PHR work Â cross Indiaâ.
Dr Annie Stanley Thakore, HospitalÂ Administrator, CARE HospitalsÂ says, âIT will re-define healthcare.Â Most of us are moving towards anÂ EHR system that unifies patient records.Â But the new-era EHR will provideÂ the clinician with systems thatÂ could dispense the Â course of actionÂ through analysis of the past historyÂ and assessment of the present healthÂ issue. Doctors should be able to focusÂ on Â making real decisions that requireÂ human judgment aided by ITâ.Â
The use of standardised EHR and theÂ secure exchange of health informationÂ improve healthcare quality and safety,Â and reduce healthcare costs by:
a)Â making health information availableÂ to authorised healthcare providersÂ wherever and whenever a patientÂ gets care, improving the coordinationÂ and continuity of care and promotingÂ informed decision-making
b) givingÂ consumers more complete and accurateÂ information to inform decisionmakingÂ about their own healthcare
c)Â reducing preventable medical errorsÂ and avoiding duplication of treatmentsÂ and procedures
d) lowering adÂ ministrative costs and reducing clericalÂ errors
e) enhancing research byÂ facilitating the collection of standardisedÂ data to evaluate promising medicalÂ techniques, devices and drugs
f) reducing the time it takes to bringÂ safe, effective products and practicesÂ to the marketplace.
Dr Munuswamy says, âEHR, EMR &Â PHR when fully developed will changeÂ the entire healthcare service architecture.Â Healthcare consists of fourÂ broad and slightly overlapping verticalÂ components; surveillance, diagnostics,Â management and follow-up. AnÂ efficient EHR, EMR & PHR can makeÂ surveillance proactive, make way forÂ continuous diagnostics, real time evidenceÂ led decision support systems forÂ health professionals and automate follow-Â up leading to enhanced their qualityÂ of care, reduced healthcare errors,
increased collaboration, and hopefullyÂ adoption of healthy behaviorsâ.
Mukherjee says, âHealthcare IT inÂ US is very much controlled and drivenÂ by different Healthcare Acts. Unfortunately,Â it is not the same in India. InÂ India, patient safety has always beenÂ overlooked and hence there is an urgentÂ need of addressing this matter.The EMR, Interoperability, CCHITÂ certificate, Telehealth and use ofÂ âmeaningful useâ is among the mostÂ discussed topics todayâ.
âThe state or perhaps the centre has toÂ take the lead, in developing a central EHRÂ back bone and enable or incentivise privateÂ healthcare facilities to set up infrastructure toÂ link up to the central EHR. Facilities which areÂ receiving state insurance payments could beÂ the starting pointâ
Dr Suresh Munuswamy, Faculty for Health Informatics, Senior Lecturer,Â Indian Institute of Public Health, Hyderabad, Public Health foundationÂ of India
On the flipside
Its one thing to have your financialÂ information online, but your health informationÂ is another story altogether.Â Many people have real fears aboutÂ what could happen if their medical recordsÂ fell into the wrong hands. TechnologyÂ must play a central role forÂ proposed healthcare reform to containÂ costs, improve access, and save lives.A smart, ubiquitous electronic medicalÂ record system is certainly a bigÂ part of the package, but will we haveÂ to sacrifice our privacy to reach theseÂ lofty goals? An EHR is only as good asÂ its availability. All these benefits areÂ only possible if the information is inÂ an open network and everyone withÂ permission has unfettered access.
We need to be able to implementÂ an electronic medical record whereÂ physicians can talk to each otherÂ about patients, and hospitals and physiciansÂ can communicate back andÂ forth and share critical informationÂ on tests done and previous diagnoses,Â so that everyone involved has the patientâs Â medical history at their fingertips.Â This will ultimately save moneyÂ by reducing unnecessary, repeat tests,Â and cutting back on the time it takesÂ to make diagnosis.
Elements of EHR
The following forms parts of an EHR:
Health information and data: The system holds whatâs normallyÂ in a paper chart â problem lists, medication lists, test results
Results management: An EHR lets you receive lab results,Â radiology reports, and even X-ray images electronically
Order entry: No more prescription pads, all your orders areÂ automated.
Decision support: An EHR is smart enough to warn you about drugÂ interactions, help you make a diagnosis, and point you to vidence basedÂ guidelines when you ponder treatment options.
Electronic communications and connectivity: You can talk inÂ cyberspace with patients, your medical assistant, referring doctors,Â hospitals, and insurers securely. And your system interfaces withÂ everyone elseâs. Interoperability is the key word.
Patient support: Patients can receive educational material via theÂ EHR and enter data themselves through online questionnaires Â andÂ home monitoring devices.
Administrative processes: The system lends a hand with practiceÂ management. Patients can schedule their own appointments and
staffers can check on insurance eligibility.
Reporting and population health management: How manyÂ patients did you treat for tuberculosis in 2013? An EHR will spit outÂ the answers, thanks to a searchable database.