Healthcare Industry today is at cusp of the transformation and major credit for this metamorphosis goes to the digital boom which not only has scaled up things but also led to enriched healthcare experience and hassle free services to patients. COVID-19 has glaring example where technology has proven its heft. Electronic Healthcare Record (EHR) is digital health record of a patient which can be accessible anytime anywhere thereby making whole clinical workflow an easy task. Mukul Kumar Mishra of Elets News Network (ENN) explores various aspects of the tool.
Information and Communications Technology (ICT) has created a paradigm shift in the way patient clinical data is captured, stored, used and disseminated. Earlier people used to carry a bulky file or folder comprising all medical records including test reports conducted at different hospitals at different interval of time. One can imagine how difficult it was to carry it from one place to others. Healthcare facilities also found it an herculean task to manage all records in paper format. Off late, there has been a gradual shift from paper based records to electronic records.
Electronic Health Record (EHR) is simply storage of a patient’s health related information in a digital format which helps doctor to get clear cut picture about the medical history of a patient. These patient centered records are available anytime for authorized users, thus easing the clinical workflow. The healthcare team has real time access to the entire medical history of the patients including the diagnosis details, the treatment plans and aftercare, allergies to medications, lab test results, and more.
EHR—Market opportunity and its benefits
New data suggests that the Indian electronic health records (EHRs) market, which accounted for approximately 9% of the Asia Pacific (APAC) EHR market in 2018, is expected to grow at a compound annual growth rate (CAGR) of 5% through 2025. It has huge potential to turnaround things. Owing to the numerous benefits it offers, EHR has become an inevitable tool for hospitals as well as private health practitioners across the world. It fosters better health outcomes while reducing costs for both the healthcare provider and the patient. It negates medical error leading to improved diagnostics and patient safety. Moreover, it contributes to higher patient engagement and facilitates enhanced care coordination.
EHR vs EMR
It is important to note that Electronic Health Records differ from Electronic Medical Records. Electronic Medical Record is a digital version of paper record related to patient’s medical history recorded in a clinician’s office. Electronic Medical Records are not designed to be shared outside an individual clinical practice. On the other hand, an Electronic Health Record is a comprehensive report of an individual’s overall health. Electronic Health Records is a collection of various medical records. It is designed with an intention to be shared outside the healthcare organization. However, some people still use the terms “Electronic Medical Record (EMR)” and “Electronic Health Record (EHR)” interchangeably.
Public healthcare lacks ICT infra
The Government of India recently came up with National Digital Health Mission, which aims to bolster digital infrastructure of healthcare system to facilitate accessible and quality care to people at large. Over the years it has undertaken number of steps pertaining to EHR, but barring few government hospitals like AIIMS, none can boast about its digital infra. A 2018 report by the ministry of electronics and information technology on EHR, states that government hospitals and dispensaries have poor ICT infrastructure. The report pinpointed challenges range from infrastructure creation, policy and regulations, standards and interoperability to research and development.
To achieve Universal Healthcare, India needs to have robust EHR system in place. The Government should have strict policies and incorporate EHR standards compliant software in public healthcare network to ensure that all the stakeholders – hospitals, patients, insurance companies, research establishments – are benefited.
Here’s what experts’ say about the tool, its benefits and challenges:
In India the Patient data resides with different healthcare providers and in different shape. So it is very highly impossible to keep this information in a single format. This is the biggest challenge for a patient himself.
Another challenge is for Government that how this system will cover up our entire population. From the birth to the death of a person entire data remains with the Government as well as patient himself. This will help to make controlled Medical system in the country with better predictive information and cost to the care. Last major challenge is data validation and insurance based medical system. The first is the technical challenge and rest two are administrative challenges.
COVID Benefits/Task to-do to accelerate the digitalization
Despite benefits such as improved patient care coordination and access to patient information, the electronic medical record (EMR) in its current state poses significant barriers to infection preventionists (IP) work efficiency during a pandemic. The 2019 coronavirus disease (COVID-19) pandemic underscores both the importance of IPs to the healthcare system and the need for an ever strengthening partnership between IPs and information technology (IT). Many aspects of IPs day-to-day work involve manual surveillance to determine whether an infection is hospital-acquired. Hospital acquired infections are infrequent events, allowing for a manageable combination of IP surveillance via manual and automated processes. The reliance of manual case identification differs in a pandemic as suspected or confirmed COVID-19 cases are increasingly frequent, real-time events.
Increased COVID-19 testing highlights EMR barriers to effective infection prevention practices. Prior to future pandemics, healthcare systems must anticipate EMR barriers and design solutions in advance. EMR barriers highlighted during the COVID-19 pandemic include rapid notification of suspected or confirmed COVID-19 patients, tracking suspect or confirmed cases who have been tested at an outside facility or during a previous hospital visit, and triggering the automatic implementation of isolation .Because most EMRs do not communicate between health systems, delayed IP notification of suspected or confirmed COVID-19 patients at the time of facility-to facility transfer may hinder prompt application of appropriate isolation precautions and lead to staff exposure.
So our expectation is to have an EHR as not only “System of Record”, it should be act as Clinical Assistance to the doctor. An EH R is not only for a single healthcare provider, it should be “Global” in nature.
Why EHR is must have story to the Healthcare Organization and Healthcare Providers (HCPs)’
To go Paperless at the private or public healthcare providers will not have choice to adopt the technology. Without adopting the technology, it is impossible to maintain the patient clinical longitudinal records which could be accessed by the clinicians at point of-care as it would be helping the healthcare organization to improve the patient & provider experiences. The first and foremost advantage would be to achieving the goal to stop the clinical errors due to which several deaths take place.
A Couple of years ago ,a study by the Harvard University showed that nearly 5,000,000 (5 mn) deaths occur in India annually due to medical errors triggered by lack of technology adoption among the doctors and nurses to handle patients when brought to the hospital.
Therefore deployment & adoption of real-time EHR would be one of the best tool to get-rid-off from this disaster which happens knowingly, un-knowingly as EHR plays a vital roles of Clinical Decision support system(CDSS) at point-of-care to the clinical users to deliver the quality healthcare. The EHR application notify the clinical users via cohort clinical reminders, drug to drug interaction, drug to allergy interaction, drug to laboratory test interactions, drug to food interactions ,contrast media interactions with other drugs and clinical tests which could be embedded to the clinical workflow / clinical pathways based on the signed, symptom, provisional and final diagnosis.
On the hand, the technology adoption is being enforced both by the patient and the doctors due to Covid-19 pandemic whereby adoption and usage of telehealth/ telemedicine is one of the best examples. Telehealth solution must be working with CDSS as must have feature in the enterprise EHR solution stack instead of treating it as a separate component / tool. Thus, the challenges of adoption have been addressed up to some extend and it is the right time for the Healthcare organization to accelerate this opportunity and come out from the technology adoption issue from the clinical users / clinical fraternity to the Indian healthcare industry.
‘Handwritten paper records prone to medical errors’
Handwritten paper medical records may be poorly legible, which can contribute to medical errors. Preprinted forms, standardization of abbreviations and standards for penmanship were encouraged to improve the reliability of paper medical records.
Electronic records may help with the standardization of forms, terminology and data input. Digitization of forms facilitates the collection of data for epidemiology and clinical studies. However, standardization may create challenges for local practice. Overall, those with EMRs, that have automated notes and records, order entry, and clinical decision support had fewer complications, lower mortality rates, and lower costs.
Still in India it is not very popular as doctors and nursing staff don’t like to spend much time entering data on computer. They feel comfortable at hand written notes.
‘EHR very useful to give batter clinical treatment and quality care’
Today, patients are more educated and better informed. They use smart phones and social media. Due to more awareness about latest technological tools, their demands are also going to change.
Nowadays, every patient wants their data on hand. They want to carry all the clinical record on their mobile. To cater their demands, Public and Private Healthcare service provider have to adopt digital platform, which give mobility and data availability. So patient may not need to stuck due to physical data. They can take treatment anywhere in any hospital by providing his clinical history detail so he can get batter care.
If we see business prospective, EHR is very useful to give batter clinical treatment and quality care. It also helps to improve patient experience. Talking about public healthcare service, they have big volume of patient considering this EHR will help them to atomize clinical care and online patient data will help the community to take continues clinical care in any hospital.
CIMS Hospital is one of the first hospitals in Gujarat who has adopted digital ICU concept. We have almost 75+ modules which have covered most of the back office process and we are into implementation phase of EMR for OPD and IPD.