Saturday, 11 July 2015

Electronic Health Record - A change that needs to be adopted

The world is day by day drifting towards the electronic and digital media. Almost everything that we currently have is available online and that too with reviews. So this makes our life a little easier and provides us with varied options to choose the best available goods online. Well call it change or revolution but it's all good.

This so called change is not just applicable to the ever growing e-commerce industry but its even applicable to the healthcare sector. The change that is coming up in the healthcare sector is the storage of records which means that the hospitals have now started storing the records the electronically. It all started in US in 1985 when the Department of Veterans Affairs already had the automated information systems in its medical facilities. They had the Decentralized Hospital Computer Program (DHCP) which had the functionality to assist the extensive clinical and administrative capabilities. The system was further enhanced with the introduction of Computerized Patient Record System (CPRS) in 1997.

What was known as DHCP in 1985 is now known as Veterans Health Information Systems and Technology Architecture or VistA or more commonly called as Electronic Health Record (EHR). The EHR at this point in time has become a key feature in United States as it has been mandatory by the US Government. So what exactly is an EHR? Electronic Health Record is a digital platform that collects all the patient data (no matter how many times the patient has visited the hospital) at one place making it easier for the hospital administration to track and seek assistance. The patient record includes the demographics, the vitals such Blood Pressure and or Pulse Rates, problems that a patient suffers from, past medical history, lab tests and radiology reports and immunizations. It also captures the medications given by the treating physicians, the name of treating physician(s) and many more. So ideally this becomes a one stop platform for the concerned physician and the patient as well. So no matter how many times the patient has visited the hospital and no matter what number of patients have visited the hospital EHR stores the data in one place and is easily accessible.

However when we talk about India, EHR has yet not gained that much of popularity. There are many reasons for it but what I can think of is that the hospitals having a larger bed size (> 500 beds) have their own inhouse team to develop the software where-as the hospitals with lesser bed size (<200 beds) does not need it as they are satisfied with the HIS system. So there is still a segment that the EHR Vendors can target to sell off their software. So what technique should (specially) the vendors follow to achieve the sales of software. Let me help you out .

First you need to understand the fact that India as a market is not ready to adopt the electronic change or reform in the healthcare sector. On the other hand I would also add a point that there are certain hospitals that have adopted the change. All India Institute of Medical Sciences (AIIMS) has this software implemented in 3 of its branches (Bhopal, Raipur and Delhi). Similarly Max Healthcare has also brought about this change. But still there are hospitals that are not ready for it. So in order break that barrier follow these tips -

  1. Right Approach - As a software vendor one feels that its best to approach the IT Department of a hospital but then that's a myth and the right approach is the Top-Down approach. You need to meet the top level leadership to showcase what you got. It's then the responsibility of these top level executives to convey the message to the rest of the hospital administration that this is an organizational reform and priority and will be a transition for the entire organization. if you think that the top level wouldn't understand the nitty-gritty of EHR then you have lost the battle because they are fully aware of the functionality of EHR. It's also imperative for a vendor to make sure that when they are meeting the higher management staff, there has to be someone from the IT Department of the hospital and from the vendor side. This will make a two way communication and product understanding will be clear.
  2. Completed Software - As a vendor it is always difficult to commit a date when the software will be complete. And it is better not to commit anything if you have already spoken to the hospital. Tell about what you have however I would suggest not to focus on sale of the software the moment you have started to work upon it. Ideally complete all the modules of the software and give the hospitals a customized version suiting their needs. Once the software is ready its better you do some research about your competitors and research about their software. You can get the complete list of companies dealing with EHR by clicking here
Most widely used EHRs
These two tips are for the vendors who fail to sell their software in the market that is not ready however when it comes to hospitals its a bigger challenge. No matter how complete the software of a vendor is there are hospitals that do not agree. So here are tips for the hospitals that will help them embrace the much needed change:
  1. Right Leadership - As mentioned above this is the most important factor not just for the vendor but also for the hospitals. There has to be a Top-Down Approach for inculcating any change. ideally the change will start from the board but it should also include the other members of the organization addressing the fact that the this change is for the smooth functioning of the hospital.
  2. Define the vision - The administrative staffs need to share their vision with mid level employees. It should be made clear that with the adoption of EHR the human error is reduce to a great extent with actually results in increased safety of patients. 
  3. Proper Engagement - You just cannot hire a vendor and kick start the use. You need to engage the physicians and nurses who will work in collaboration with the IT Dept to learn and understand the requirements. 
  4. Adequate Resources - The hospital needs to ensure that they have adequate resources such as finances, technical infrastructure and manpower because installing a software is not the end of it. It is a continuous learning process. The clinicians should be supported everytime they design a workflow or training.
  5. Effective Training - Installing a software does not just mean installing it. Before it goes live in the hospital systems there should be proper training given to the staffs to attain a free hand on this complex software. It is advisable that the hospitals should seek help from the Vendors as they are the subject matter experts.
  6. Engage with the Right Vendor - When installing EHR in your premises you need to make sure a) it follows the ICD-10 compliance b) complies with the Meaningful Use. The Meaningful Use of EHR is basically improvement in quality of treatment, safety of patient, keeping the friends and families of patients engaged which will eventually result in better outcomes for the hospital in all fronts. So you need make sure that the software matches these two main aspects as well. 
So I guess these two aspect of two different community is actually needed for the successful implementation of EHR. However it is time now that the hospitals in India should actually adopt this change which will help the better functioning and reduces the health hazard to the patients. The fact is human error is reduced to a great extent because the software itself will prompt you about any adverse affects a medicine can have on patient. Or it can even tell you or give you a prompt whether a particular patient needs to undergo a particular test or not.

To know more about EHR click here.

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