Since the start of an era with accessible health care, we have flocked the gates of numerous healthcare providers/hospitals to gain the best care and cure. Records are maintained usually by the institution or the provider for future reference, surveys or follow-ups. The patient’s medical history, treatment, allergy history, laboratory values etc.is stored in a printed or a written file. This is basically a gold mine for physicians and healthcare providers which is not being used to its fullest potential. According to studies, at least 48% of the adverse events occur due to errors which were preventable, 28 % due to negligence and 17% due to complications from adverse drug events. Errors from lack of information or medical records related to the patient’s condition are easily preventable with accessible, tangible and reliable record keeping.
Integration of medical records into a computerized and systematic form, storing patient’s medical information within the easy reach of the physicians and providers is what is known as Electronic Medical record or Electronic Health record. EMRs will contain complete medical history related to the patient, diagnosis, treatment provided, drug allergy, immunizations, laboratory reports and radiological findings. This entire information can be used to streamline the clinical care output along with evidence based care. Intuitive decisions based on the experience of the physician leads to higher percentage of error than a synthesised decision taken, based on the information provided by EMRs. For the success of EMRs, its wide scale adoption is key, for better quality management and reducing treatment delays. Provider centric EMRs allow easy access to physicians with minimal access to patients.
To help patients gain reliable clinical facts from the entire web of information, EMRs are made patient friendly. Patient centric EMRs are an easy variant of basic home kept medical records. Data stored by the patients with help of prompted questionnaires about the symptoms, behavioral and habitual changes, can be brought to the next strata with clinical information pertaining to the condition is provided. It often contains unmodified content and advanced terminologies leading to minimal understanding and undue anxiety. This barrier can be dealt with the help of clinicians dispensing medical advice by familiarizing the patient with the condition and to take the next best step for treatment. EMR for the patients comes with added benefits with reminders on health check-ups and follow ups.
Regarding its acceptance by various providers and patients, the United States passed an act in 2009 which gave further incentive to adopt EHRs and thus enhancing the quality of care. But due to various issues regarding its implementation and security, its adoption has been slow. The United Kingdom, along with the US based company, Computer Sciences Corporation began its largest IT integration in early 2002 with a national electronic record system. It eliminates the challenges of interoperability among various EHR systems. India with its large and diverse population running in billions has made it even more challenging for the adoption of EMR as a majority of the population reside in rural areas with minimal access to technology. The National knowledge commission aims at establishing national standards for EMRs and interfaces created by various IT vendors. The process of its implementation has taken motion at a slower rate than expected due to its multiple challenges. The health sector in India comprises the public and private sectors with public sector coming under the dominance of Government of India. A major section of the urban population prefers private health care for its benefits and care, which makes it a good region for implementation and operability of EMRs with help of external vendors.
- Minimising preventable errors by physicians with the help of EMRs containing a complete history and treatment provided.
In patient-centric EMRs, social and behavioral aspects are taken into account which weighs in the need for any form of counseling.
- Improving the quality of care and removing treatment delays by sharing the records with reliable health care providers under whose care the patient is admitted.
- Presenting a reminder to patients about borderline lab values or monthly/yearly check-ups.
- Improving accuracy of treatment.
- The multitude of data which can be used for surveys and research benefits mainly in provider centric EMRs.
- The major challenge in patient-centric EMRs involves the lack of access and distribution of technology in India. In the private sector, this gap is reduced with a better chance of acceptability.
- Unmodified content supplied through the EMRs can bring undue anxiety and confusion in patients seeking out for varied diagnosis and reduced satisfaction with the care provided.
- Time is a constrained factor mainly for physicians to familiarize and implement it. Productivity drops have been noticed with an introduction of newer methods. The complexity and operability of these systems require further learning for its acceptance.
- Financial costs to maintain advanced record keeping with every level fulfilled includes multiple IT vendors and suppliers.
- Patients are often at a loss to opt for such complex interface leading to its reduced functionality.
- Interpersonal communications between the patient and the clinician are disrupted.
- Issues regarding reliability and dependence of the vendors providing the technology for EMRs are another challenge yet to be tackled efficiently.
The ease in access provided by the EMRs to patients makes it appealing to them but its higher functionalities depend on the acceptance and adoption by both the physician and the patient.
The main barrier to be dealt with is the need of a reliable, accurate, tangible and user friendly interface along with its adoption by both the physician and the patient. The external vendors providing the interface require a higher amount of operability and security features to reduce any breaches. The time constraints encountered especially by the physicians, leading to its slower adoption rate, require management and learning during their training phase.
EMR in India, especially with its vast population, is like an untapped gold mine which still has a long way to go in its implementation and acceptance. It requires the cooperation and collaboration of both public and private sectors and making its acceptance a success.