Adoption Of EMRHER

By Girish Koppar, Sr. Manager – IT, Lilavati Hospital & Research Center Secretary H.I.T. Association


EMR (Electronic Medical Record) or EHR (Electronic Health Record) are often used interchangeably but there is a vast difference between them. EMR is mainly used for Diag­nostics and other treatments (main­ly clinical) and is local to a hospital wherein the doctors can view the records/data of a Patient whose in­vestigation/treatment has been done in the respective hospital. Usually EMR is the property of the Hospital and the Patient may or may not have access to his/her data.

EHR is more Patient centric and like a Digital Health Wallet of the Patient having his/her historic clini­cal data and real-time data which is being captured through vari­ous portable/non-portable devices. EHR contains many other things than just Diagnostic information of the Patient. It includes historic medical data, allergies, immuniza­tion details, demographic, insur­ance details, Radiology images, etc. EHR can be used for preventive and predictive care as well as insurance purposes and can easily be shared with other specialists, pharmacies. It can be very useful and of great help in emergency situations and can be shared with any other provider in the Healthcare ecosystem.

Stages of EMR Adoption:
• Stage 0: All Three Ancillaries ((laboratory, pharmacy, and radiol­ogy) Not Installed.
• Stage 1: All Three Ancillaries In­stalled - Lab, Radiology, Pharmacy
• Stage 2: CDR, Controlled Medi­cal Vocabulary, CDS, HIE Capable
• Stage 3: Clinical Documentation, CDSS (Error Checking)
• Stage 4: CPOE(Computerized Physician Order Entry) or E-pre­scription; Clinical Decision Support (Clinical Protocols)
• Stage 5: Full R-PACS
• Stage 6: Physician Documentation (Templates), Full CDSS, Closed Loop Medication Administration
• Stage 7: Complete EMR, Data Analytics To Improve Care

Current Scenario:
The adoption of EMR/EHR in US and other Western countries is higher as compared to our Indian counterparts. This is mainly be­cause of the following

• The investment on IT is much higher in the US & Western coun­tries than the Indian counter­parts.
• The Insurance is directly inte­grated with the Hospital Man­agement System and it is virtual­ly not possible to process claims without technology adoption.
• Doctors are more open minded when it comes to adoption of tech­nology in the west and it has a direct impact on their payouts.
• EMR adoption is seen higher in some of the corporate run chain of hospitals and the newer hospitals where the business processes are not defined.

Following are the major challenges for EMR adoption in Indian scenario in running hospitals

• There is a huge investment needed in technology to amend the application.
• The Business processes need to be tweaked/modified for adoption of EMR.
• Training needs to be provided to all the stakeholders to adopt newer technology. It has been seen that there is a huge resistance from all the stakeholders to adopt to newer technology as they have been using the legacy ap­plication for the past many years and may not have the necessary skills to use newer technology.

" The adoption of EMR/EHR in US and other Western countries is higher as compared to our Indian counterparts"

To overcome the above challenges a lot of will, drive and initiative from the senior management to get EMR implementation. Hence the Organization needs to have a top down approach for successful EMR implementa­tion.

Advantages of EMR/EHR:
• Availability of data at a click of button This is the major advantage from the Patient’s per­spective as his/her data is secure in the database of the Organization and he/she need not carry the baggage of reports every time he/she visits the hospital for any consultation or admission. The Doctor can view the Pa­tient’s present and past records at the time of consul­tation which will in turn help in better diagnosis and treatment. Also, it becomes easy for the Patient to share his/her records via email or a link to any other doctor who is based at a remote location for a second opinion.

• CPOE or E-prescription
EMR/EHR also helps the doctor in prescribing medicines and investigations digitally to the Patient and the digital copy can be mailed to the Patient and accessed by the in-house Pharmacy to dispense medicines. Also, due to EMR/EHR the application prompts the doctor for any drug to drug or disease to drug reaction whilst pre­scribing medicines.

• CDSS (Clinical Decision Support System)
EMR/EHR is the basis for setting up a CDSS which provides the doctor data in ana­lytical manner thereby helping the Doctor or Clinician in better diagnostic decisions.

• Health Information Exchange or Population Management
EMR/EHR can also be used by the Government or Mu­nicipal authorities to understand the trend of diseases demographically, gender wise or any other parameter what diseases or viruses are prevailing in a particular area or for a particular gender, age group, etc. On adoption of EMR/EHR real time data would be available with the Government and Municipal authorities so that they can take necessary preventive action on the outbreak of an epidemic or disease. The Insurance Industry can use this data to study the trend of claims from the various Patients and design their Insurance policies accordingly.

• Predictive Analysis and Artificial Intelligence
EMR/EHR data is an input to Business Intelligence & Analytic tools to dice and slice the data for preven­tive as well as predictive treatment of the Patients. The data will also be an input for Machine Learning and Artificial Intelligence.

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