Sunday December 17, 2017

EMR: Electronic Medical Record, lest it becomes another CLERICAL RECORD

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Image from www.breadforthecity.org

By Dr. J.K. Bhutani

The Technology is becoming a big charm, attraction and a fancy for the populist governments. The recent ‘Digital India Initiative’ is enamouring people, youth and the governance as much as Telecommunication and Computer revolution of Rajiv Gandhi did India in the 1980’s. The fact remains that technology is an empowering, enabling tool and an equaliser of masses to enjoy the real benefits of democracy.

Image from www.breadforthecity.org
Image from www.breadforthecity.org

Haryana government launched ‘e-उपचार’ today, a HSHRC (Haryana State Health Resource Centre) initiative to computerise the hospitals of Haryana. The proposed key benefits include registration of the patients with a unique health identification number (UHID), maintaining electronic medical record of the patients including the disease data, lab reports, investigation plan, hospital stay and discharge with a hope to provide queue less services with a tracking facility for the patient and the officials.

The Electronic Medical Record, EMR as practised in USA, is a unique robust health delivery, research,  resource planning and database tool. It empowers patients and service providers alike and avoids the redundancy and duplicity of data. Currently in the United States, 78.4 per cent (2013) of office based physicians use an electronic medical record system for managing their patients, as per CDC data. There are numerous features of EMR systems in US which make it robust, widely acceptable, and beneficial to both patient and the care provider.

Hospital Management and Information System -  HSHRC.clipular

As the patient comes into the hospital, a new record in the database is created and the demographic details are entered. As he moves on, raw anthropometric data is entered by the nurse practitioners. The physician is then notified of the updated records, and is given due time to review this data. During the actual patient encounter the doctor can use this record to re-assess any important vitals or diagnostic studies. Further, after the patient encounter is complete, the doctor makes a note of his history and relevant findings, and orders relevant investigations and drugs.

The investigations are sent directly to concerned departments, where they can be accessed and completed by another care provider. The drug orders are sent directly to pharmacy outlets, which are pre-programmed in the system. The patient can ask the physician to send his drug orders to a pharmacy store which is easily accessible to him. Whenever there is a new lab report/order that comes in for this specific patient, the attending physician is notified on his home screen and is asked for any review of orders. A follow up visit if scheduled by the attending physician is automatically managed by the EMR system, and the patient gets notified of it a week prior by SMS/E-Mail.

Other features to add to the power of EMR include graphic representation of data, which help doctors to review reports easily, and further use it for presentations. Also, disease surveillance, daily census of diseases, regular audit of quality of healthcare offered by the hospital are made extremely simple with EMR use.

Due to wide acceptance of EMR and mandatory implementation in any hospital based setup, healthcare data transfer has become seamless in US. There is no factor limiting inter-hospital, inter-provider data access. However, this does have a privacy check, where in the patient’s physician has to authorize the access of data by another, thus maintaining patient confidentiality successfully. Lastly some EMR systems support patient himself accessing his results at home, using simple mobile applications.

The most popular EMR software in US are eClinicalWorks, McKesson, Cerner etc. though their implementation is limited by high cost of installation and maintenance.

Now once we have the will, funds, tools and the DIGITAL acceptance, Haryana should take the lead. The things should be placed in the right perspective and hands. All the doctors should be trained in the EMR to have the best of the best database which can benefit the patients for equitable services, governments for resource planning, database of the diseases and treatment outcomes for research use and teaching.

It shall go a long way if it is linked to Aadhaar card number, so that wherever the patient goes/travels/migrates the database and the health record of the patient goes along with him for reference and use of the health care providers. Gradually but mandatorily all the private practitioners, clinics and hospitals should be partnered to use same government linked EMR to maintain universal access and reach of the EMR..

A strong framework, training of the manpower is a crucial component to NOT let it regress to mere computer operator generated name, father’s name, OPD slip or discharge slip data records.

JK1Dr J.K. Bhutani MD is a protagonist of preventive and promotive health care based on austere biology and facilitating self healing powers of human organism.
You can follow him at  https://twitter.com/drjkbhutani

 

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Now, AIIMS patients can book OPD appointments via App

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AIIMS files (3)--621x414

By Newsgram Staff Writer

In a first for hospitals in India, the All India Institute of Medical Sciences is all set to launch an Android mobile application for the convenience of its patients to book and cancel OPD appointments, and access their laboratory test reports.  The new system known as ‘IVR Based appointment system’ makes it likely to book appointments.

The beta version of the app is out for use but only Old patients having UHID (Unique Health Identification number) can avail benefit  from it.

“The final version will be launched in the next few weeks after correcting all the bug reports from the beta version. The UHID requirement will be removed to make it possible for anybody who may not have visited AIIMS before to create a UHID with the app and then carry on with the functions of the app. So effectively, patients will have to just visit the hospital to see the doctor,” said Dr Deepak Aggarwal, professor of neurosurgery and in-charge of the hospital’s IT cell.

Keeping in sync with the digitization of services, this step is a welcoming one. This system is currently offered in two languages, English and Hindi. Based on the lines of IRCTC, there will also be a 25 per cent ‘tatkal quota’ for new walk-in patients for each department.

Private healthcare chains like Dr Lal Path labs, Max hospitals and Fortis already have an app for patients to access services and reports online.  This app designed by National Informatics Center (NIC), will soon be available for ios users.

“We have kept the interface as simple as possible, to keep it legible and clean. The immediate plan is to broaden the app by removing the UHID requirement, and then link it to Facebook or other social media platforms.” said Nikaash Puri, an independent developer of the app. He said that while the software is currently available only in English, it would be linked to Google Translate in the next three-four months to make it available in 12-15 languages.

AIIMS is also expected to incorporate their UHID system with the UID provided by the government, by April. Patients who do not have the app can do the same things on the AIIMS website under a section called patient portal.  With a view of making medical facilities mobile for people across India who visit AIIMS for treatment, this app is a way forward to do so.