March 2008

Implementing EMR

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When introducing EMR to the hospital environment, it is critical to establish a Hospital Information System (HIS), prepare and involve various stakeholders (internal and external) and define a clear implementation path for EMR. All components of EMR must be compliant to integrate with other existing information systems in the hospital.

The increasing demand for quality care with rising competition has made hospitals maximize utilization of technology in driving processes and streamlining operations. Not only corporate, but also stand-alone small and mid-size hospitals have woken up to the adoption of Hospital Information Systems (HIS) making it an integral part of hospital management. Similarly, EMRs (Electronic Medical Records) are making their way into the hospitals but at a slow pace. Only  large corporate hospitals are implementing EMR applications today,  whereas most of the other hospitals still maintain the old format of paper based records.

 

 

 

 

 

 

 

 

Definition

Electronic Medical Records (EMR) or simply 'medical records in an electronic format' is a complex system consisting of critical clinical information. EMR systems have the following key features:

  • Patient's Clinical information: medical history, prescriptions, allergies, diagnosis, reports, etc. 
  •  Clinical decision support databases: databases which help in making decisions during prescription writing, drug-to-allergy database, etc.
  •  Orders Management: order entry, retrieval, result reviewing, etc.
  •  Work flow management: managing processes like appointment viewing, check-in patients, review, etc.
  •  Security features: for maintaining security and confidentiality of critical information.
  •  Electronic Prescription tool: for writing and managing prescriptions
  •  Patient's financial records: service bills, receipts etc.

EMR is an evolving technology that is being adopted by healthcare facilities as part of an ongoing trend to maximize efficiency and streamline functioning.
 
Pre-requisites

When introducing EMR to the hospital environment, it is critical to establish a Hospital Information System (HIS), prepare and involve various stakeholders (internal and external) and define a clear implementation path for EMR. All components of EMR must be compliant to integrate with other existing information systems in the hospital. The other major factors to consider include:

  •  Ease of use: most critical, as EMR will be used mostly by clinicians, who are rather reluctant in adopting technology to be used in parallel along with their care services  
  •  System Interoperability:  capable enough to interface and interact  ith other information
  •  systems  Standardization: standard compliance to avoid data loss/ inconsistency when interacting with other systems
  • Work flow capacities: ideally only full solution systems should be adopted 
  • The sales team of the chosen vendor: a good fit is crucial for success since these are frequently long term relationships 
  • Vendor Services: good vendor after sales and maintenance support services are crucial

 Trends

In India, the number of patients-to-hospital bed ratio is high, that is, there are far more patients compared to the number of hospital beds available. Hence process efficiency, i.e., quality care services in less delivery time are necessary. In this scenario, EMR benefits a hospital as it provides:

  • Faster accessibility to records
  • Less storage space
  • Security of information
  • Any time, anywhere accessibility (e.g.,  remote access from hand-held devices)
  • Easy to manage as compared to paper based records

The slow adoption rate of EMR is the main factor for the slow growth in the market along with the attitude towards its adoption. The necessity for implementing basic information systems in hospitals has been felt, resulting in more hospitals adopting them. But again, the reluctance from the key users of these systems still remains a big challenge for the hospitals, specially the clinicians. Low IT investment is the other key factor affecting the adoption.  

The big question remains: are Indian hospitals ready to go totally paperless?       

Paper-based medical record maintenance in itself, is a huge task because of the space, manpower and time required for maintaining (that is, creating, filing, retrieving, etc.) these records. This requires special space and manpower in a hospital, dedicated for record keeping.

On the other hand, EMR helps in saving this cost of space and time to maintain and retrieve records. Paper-based records are still the most used form of medical record keeping. Though corporate hospitals are the front-runners in adoption of electronic medical records, research shows that only 15-25 percent of paper work is reduced after implementing EMR in an Indian hospital.

Major Players

Some of the major EMR providers in India include: 

  • GE Healthcare 
  • IBA Health
  • VEPRO
  • Siemens
  • Karishma Software 
  • Sobha Renaissance IT Pvt. Ltd.
  • 21st Century Healthcare solutions 
  • Softlink International
  • Prognosys
  • Srishti Software
  • CDAC
  • Televital

Today, EMR is being largely used in big hospital set-ups to share information within hospital(s). This eases the burden of a physical record file and helps patients share their medical records easily with other clinicians. But it is still not easy to share EMR with other healthcare service providers due to lack of standardization and integration capabilities amongst two different EMR applications at hospitals. Format of one EMR may not be readily acceptable by the other hospital's EMR application. Despite these challenges, various corporate / large hospitals are still making stand-alone efforts to implement and use their own EMR applications. Technologies like hand-held devices, wireless connectivity are being widely used across hospitals. The management of these hospitals is all geared up to make best use of  he technologies available in order to improve quality and efficiency and thus are allocating separate IT budgets.   All these technological investments may not show direct cost savings or return on investments in monetary terms but they do add up to many indirect cost savings, which reflect in streamlined and efficient processes.  Drivers, Restraints and Challenges

Market Drivers

For the Indian EMR market the key market drivers are:

  • Cost Saving. Benefits in terms of cost savings result from space, manpower and time required to maintain paper-based records
  • Process  efficiency. Reduced time; as in waiting time, reporting time, administrative functions, etc. make processes more efficient
  • Better work flow through accessibility and availability. The records are available anywhere, any time through the use of hand-held devices, wireless technologies and are accessible remotely
  • Increase in Medical tourism. Efficient and quality processes of a hospital encourage more  foreign patients to access these healthcare facilities at low costs thus promoting medical tourism
  • Increasing competition amongst hospitals. With the increasing number of state-of-art healthcare facilities coming up, the competition is increasingly motivating hospitals to provide better quality to stay in business
  • Increasing awareness and demand for quality healthcare.  With increased healthcare awareness and changing lifestyles, a demand for quality services is compelling hospitals to provide better facilities and services

Market Restraints

  • High application cost: high cost of implementing EMR is affecting hospitals' move due to budget restraints.
  • Work flow Interruption: the transition to EMR systems is slow and requires a lot of dedication from all the stakeholders involved – from management (key  decision makers) to end users (clinicians, nurses etc.), which could ultimately affect the normal work flow drastically.

Challenges

The slow growth/adoption of the EMR market is attributed to:

  • Attitude towards IT adoption: there are often some people in any given hospital, who show reluctance in adoption of new technologies and are against system changes. 
  • Security and privacy issues: the patient information flowing across the system is not controlled centrally and many system users have access to it, which makes it critical to address  issues of privacy, confidentiality and misuse or mishandling. These issues are challenging and critical for the key decision makers while adopting EMR .
  • Transferring paper based information into electronic (EMR) format: the transition of paper-based records into electronic format is a manual and tedious process as it takes a lot of  time converting each record, keeping in mind the high-level of accuracy and authenticity required.
  • Long implementation time: the implementation of EMR takes a lot of time as the system is based on the key information flowing across the hospital system and involves various levels of users.
  • Employing the right team: EMR implementation usually takes a very  long time so it's important to have the right team of people with the right skills required to  implement the system. This is to avoid any delays in implementation, which may be caused due to lack of commitment, communication issues, infrastructure issues, time management issues, etc.
     

The Work done so far
 
Some of the hospitals in India using EMR are:

  • Amrita Institute of Medical Sciences, Coimbatore
  • Apollo Hospital, Chennai
  • Artemis Healthsciences, Gurgaon
  • Christian Medical College, Vellore
  • Fortis Hospital, Mohali and Delhi
  • Manipal Hospital, Bangalore
  • Max Devki Devi Hospital, Delhi
  • P D Hinduja Hospital, Mumbai
  • Ruby Hall Clinic, Pune
  • Sahyadari Hospital, Pune
  • Sri Sathya Institute Of Higher Medical Sciences, Puttaparthi
  • Sri Sathya Institute Of Higher Medical Sciences, Bangalore
  • PGIMER, Chandigarh

Benefits of EMR

Easy accessibility and availability of patient information: any time, anywhere.

  • Improved clinical decision making thus improving quality of care.
  • Reduced costs: from core administrative and clinical operations. 
  • Provides research and decision support. 
  • Increased hospital process efficiency.  

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