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

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.

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.

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.

Dr 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