April 2016

EHR – Health Record on Fingertips

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EHRImplementation of Electronic Health Record (EHR) solution has the potential to improve the quality of care and patient safety, but that’s not all; there are numerous other compelling reasons for EHR adoption by the healthcare providers, writes Arpit Gupta of Elets News Network (ENN)

Electronic Health Record or EHR can be defined as the aggregate, standards-compliant electronic record of health-related information of an individual. It is created and gathered cumulatively across more than one healthcare outlet and is managed and consulted by licensed clinicians and staff involved in the individual’s health and care. It is interoperable and can be shared across authorised care givers.

It was in August 2013 that the Ministry of Health & Family Welfare, Government of India (MoH&FW) approved the Healthcare IT and EHR standards for India, placing the country amongst the few countries in the world that boast of approved EHR standards. Subsequently, in March 2015, MoH&FW announced the intent to set up a regulatory body for digital healthcare delivery in India — National eHealth Authority (NeHA), with powers to ensure adoption of approved EHR standards by healthcare organisations. Both are important milestones and acknowledge the Government’s serious intent to ensure adoption of EHR technology by providers, which will contribute to enhancing care quality and patient safety, among other objectives.

EHR Vs EMR

An EHR is very different from an EMR (Electronic Medical Record), although the terms are often used interchangeably, which leads to confusion. The key differentiators could be that an EMR may not be compliant to any standards — though there are EMRs that comply with certain standards, all EMRs are not standardscompliant, whereas an EHR has to be standards-compliant — and is created, gathered and managed by staff from a single healthcare organisation, and is not interoperable with other care givers. Both from a patient’s health needs perspective, and from care quality and safety angle, EHRs are the right choice and they contribute immensely to a healthcare organisation’s ability to deliver safer and better services.

Adoption of EHRs is a natural progression for any organisation that would like to be ahead of the competitive curve. The benefits of EHRs are multifold, both for the patient as well as the organisation (hospital / Clinic/ heath centers) that implements it.

For care on the go

Shuchin-BajajDr Shuchin Bajaj, Founder Director, Cygnus Medicare, says, “India today has a floating population , which means a person may be born in Patna, gets educated in Delhi, does his Masters in Pune and settles down in Bangalore for his first job, and couple of years later moves to Mumbai for better prospects. With EHR this person can continue having a nomadic lifestyle but have his health records digitally secured and available at his fingertips in any emergency situation. The EHR will also help the doctor or the hospital in faster turnaround time to start treatment thus saving the time and effort in getting historical investigation and case papers prepared.”

Overall the health industry and the Government are moving towards implementing EHR on a very big scale in the near future.

“For prevention, diagnosis and treatment of adult diseases, many a time a specialist has to be consulted. Specialists in Internal Medicine, who are commonly referred to as Internists, are often called upon to act as consultants to other physicians to help solve puzzling diagnostic problems. Hence, in such cases EHR gives a complete historical perspective to the Internist, who could be sitting in another corner of the world, as EHR helps in making him available the all-crucial data and suggesting the line treatment,” Dr Bajaj adds.

Adaptability challenge

Traditional solutions are still practised and managed at mom-and-pop clinics and hospitals, as patient loyalty, especially with the older generation, has mostly been with their family doctors for all generic ailments and consultancy.

This mindset of both doctors and patients has to change. Fortunately, this practice is now changing with the next generation, which is open to the idea of change and looks forward to specialist and best treatments. EHR not only requires a defined process but also disciplined implementation practice: one may buy the most expensive Mercedes, but if we don’t have anyone who can drive it, it’s a wasted investment.

“Hence, the biggest challenge we see is data being captured in a structured format across different geographic and in real time over the years, which means it has to be followed as a standard practice irrespective of people, practice or locations.”

Also, technology is drastically changing on a day-to-day basis, so creating an EHR system that is adaptable across newer technology solutions that are quicker and faster is a challenge. The system cannot be redundant and has a short lifespan and has to last an entire life cycle of a generation, according to Dr Bajaj.

Besides, while 4G last mile connectivity would be required to implement this in remotest of remote places, India as a developing country has its limitations when it comes to lastmile connectivity

Playing it safe

Digital/electronic health records are the way forward in India but the major problem is with maintaining proper records: patients usually don’t keep their proper health records, and because of that their follow-up treatment sometimes becomes an issue. Duplication of medicines also happens because of keeping improper record. Maintaining proper EHRs will ensure that such slips don’t occur.

Not only private but some of the Delhi Government hospitals are also going the EHR way, which is a positive move.

RohanDr Rohan Khandelwal Breast Onco-Surgeon, W Pratiksha Hospital says, “EHRs are very useful in managing all ailments, especially breast cancer. Our patients remain under monitoring for long durations and proper health records help in better care. Earlier, I used to maintain the records of my breast cancer patients in a self-designed special book, but these days I have started using the EHR platform at W Pratiksha Hospital, and it is extremely user friendly.”

Despite EHR, doctors still like to write their prescriptions and integrating hand-written notes with EHR is a major challenge. Another problem faced by doctors is that operative and examination diagrams cannot be made on EHR and these have to be separately uploaded. “Also, it feels impersonal to be typing during the clinical encounters. I am aware of some incidents, where patients have given a negative feedback regarding this issue.”

IT’s omnipresent

Ashok-Jain

Ashok Jain,
Founder, Lifespan

Explaining how has IT as a part of medical infrastructure evolved in the country over the past two decades, Ashok Jain, Founder, Lifespan says, “It is fast becoming an integral part of medical infrastructure. It is becoming central to healthcare and its influence is being felt most in hospitals, chain of clinics, diagnostic Labs, etc. Every aspect of medical and healthcare is getting automated for patient’s delight. Basic things, like appointments, billings are a no-brainers, but printed advice (having the proverbial doctor’s bad handwriting on prescriptions), Electronic Medical Records, follow-up consultations through Video/ Tele/ Email/Apps, remote diagnosis and patient feedback system, among others, keep patient-doctor connected.”

Major challenges faced by hospitals or chains of clinics in adoption of IT are adoption of automation by medical personnel, availability of good software, making software and medical teams work in tandem, required investments and hassles of filing IT returns, and adoption by patients.

“Lifespan Chain of Clinics (33 clinics) is highly automated. From a call center to appointments, from visits to prescriptions, from diagnosis to Electronic Medical Records, from Web to a Mobile app — everything is automated, IT-enabled and connected. We have spent over Rs.2 crore+ on this. There is no other way – IT is the future,” Jain concludes.

Shift in trend

Today, better-informed consumer need more control over the care they want, where they receive it, and how much they are prepared to pay for it. The trend is moving away from institutionalised care in hospitals to community-based care at a lower cost.

As people live longer, clinical initiatives are moving from focussing on single-illness episodes towards strategies that embrace the needs of people with a number of associated chronic diseases. The aim is to strengthen the individual’s capacity to self manage their care and to develop flexible systems that are organised and financed around their needs. Healthier citizens generally cost less.

Effective care in the community demands digitisation of information as well as interoperability between software solutions, so that individuals and care-providers are connected to a responsive healthcare ecosystem. Each care-provider needs to be aware of what the others have done or will be doing to minimise duplication of effort and the possibility that vital issues will be overlooked.

EHRs also help improve quality of care through easier preventive care, point-of-care enhanced clinical decision support, clinical alerts, reminders and medical information leading to improved provider decision making, rapid and remote access to patient information, easier chronic disease management, integration of evidence-based clinical guidelines, sharing of information between care providers etc, resulting in better continuity of care and saving time.

Elertronic Health Records ensure that all clinical documentation is done without any ambiguity and captures important data, such as allergies, clinical findings, diagnosis, procedures, Med, Lab/ Radiology orders etc

Ambiguity given a go-by

Electronic records also ensure that all clinical documentation is done without any ambiguity and captures important data, such as allergies, clinical findings, diagnosis, procedures, Med, Lab/ Radiology orders etc. Capturing all known allergies of a patient with possible reactions and also known home medications through an initial nursing assessment in the EHR can greatly improve patient safety.

Archana-BDr Archana B, Founder & Principal Consultant, Health Corniche, opines, “Everyone who needs to know should have access to the information necessary to ensure that people lead long, healthy and productive lives. The reality is that the cost of healthcare in the world’s major economies is growing at an unsustainable rate. Many healthcare organisations are largely dependent on the desperate IT systems currently installed and many are still burdened with archaic processes. As a result, medical errors arise, operational costs increase and the quality of care compromised.”

Interoperability of healthcare IT systems, both within and beyond traditional care locations, and the progression towards collaborative care is key to improving the quality, efficiency and safety of care while ensuring the security of information exchange. Clinicians and individuals should be empowered to provide faster, insightful and more accurate diagnosis and deliver quicker treatment decisions supported by evidence-based information.

EHR on Cloud

Evolution of Cloud-based EHR is happening at rapid pace. Dr Archana further says, “We can expect major part of healthcare services to move on to Cloud and this will enable healthcare provider to offer cost-effective and efficient healthcare services. Hospitals use Cloud-based EHRs to store pathology and other diagnostic reports, maintain and store patient records/ billing/claims, integrate third-party or local applications and connect all stakeholders, including patient.”

Most healthcare providing organisations face interoperability challenges. Often they deploy multiple applications within a best-of-the breed environment that do not easily communicate with each other, even though conforming to messaging standards. The disruption or absence of timely information flow between care providers and departments impacts negatively patient treatment as well as health outcomes, and ultimately increases the cost of treatment. This problem is compounded when otherwise unconnected institutions and/or GPS seek to share information.

C-K-BabuWing Commander (Retd) C K Babu, Chief Operating Officer, dWise Healthcare IT Solutions, observes, “An EHR with an integrated good Clinical Decision Support System (CDSS) will enhance patient safety manifold. There are tangible ROI on an EHR implementation, in terms of lower cost of healthcare delivery, plugging revenue losses due to unbilled clinical services, reduction in clinical errors and medico legal cases, continuous care quality improvement, improvements in operational efficiency, increased patient satisfaction and customer retention, etc., to name a few.”

Hence, use of EHR platform addresses the interoperability challenge by providing an easy-to-use platform that enables software solutions to share information when needed and in the required form, ensuring seamless integration.

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