Implementing EHR in Indian Hospitals

How to adapt and make Electronic Health Records work in India?

When discussing the prospects of using EHR in India, I encounter the exact same questions and resistance factors as was the case in most Western countries 15-20 years ago. The Electronic Patient Records (EPR) rolled out in the UK in Mental Health between 2000 and 2005. At the time the reluctance to change came from various worries. When objectively assessed, a lot of the concerns were emotive rather than objective. My colleagues in India share exactly the same barriers, most of which is set within habit or mindset of how things have been done traditionally.  The human mind prefers familiarity and its associated sense of security rather than venture in to the unknown.

Here’s a list of issues that cropped up as typical reasons why clinicians did not wish to migrate to use of electronic care records.

  1. I have never typed or been trained to touch-type, typing takes up lot of time
  2. The EHR does not recognise speech to text (for doctors use to dictating notes and getting them typed by a secretary or sent to a transcription hub in India).
  3. The Electronic Patient Record (EPR) is clunky, dis-jointed and has too many forms and checklists to complete, none of which make my work meaningful and time-effective.
  4. Cannot access the EHR on devices other than hard-wired and networked on-site.
  5. No inter-portability with e-referrals, e-appointments, e-letters to GP and the like.
  6. No automation, the screening questionnaires are not accessed by patients online, scores are not calculated automatically, so what’s the point of bothering with the effort.
  7. Paranoia – is the data safe? Who can access it? Who controls it? etc.

Changing Mindsets towards Online EMR and its use in India:

The change of the mindsets was not easy, in fact with some clinicians it only happened when they were categorically advised that electronic records were mandatory and paper notes could not/should not be kept any more.

What happened with time is that those who did not type fast, got competent with time and practice. Others found ways in which to write brief succinct notes. The clinicians soon realised the biggest advantage of EHR was legible notes, easy access to them for other colleagues in an emergency, no need to set up clinics in advance where clerical times was devoted to fetching paper notes and keeping them all ready before a clinic.

But what about the other points? When one looks at the above arguments, all the other points  though valid were not any better when it came to running a practice, clinic or a hospital using paper notes. If anything transitioning to EHR | EPR would lead to progression to innovating with the use of IT, design of the EHR and development of APIs that allow inter-portability.

Let us also keep in mind the fact that similar concerns and barriers are fast crumbling when it comes to use of IT in banking, finance, cashless purchases or online shopping in India. It is all about change of habits. And the sooner Indian Healthcare Adopts EHR in to mainstream practice the better as we could leap frog to phase 2 and 3 of EHR developments the West are engaging in.

Most Western Countries are now in stage 2 of the above cycle, i.e. they have worked through disjointed, clunky EHRs and importantly gone past the biggest hurdles i.e. resistance from a Clinician. This has allowed the focus of the future of the EHRs to development of value added features that will overcome all of the above disadvantages.

Bespoke adaptations to EHR in India:

There is no doubt that EHR’s will need adapting to the Indian context, some key factors that need considering are optimal use of time and speed at which clinics are run in India. A typical Psychiatry OPD in UK may have 4-8 appointments, in India it is more like 20 patients in one morning if not more.

The adaptations thus will require ease of Patient Booking by Clerical Staff, Quick Patient Entry of clinical encounter in patient notes by clinician and then issue of e-Prescription. The subsequent processes should quick ICD-10 (or 11) coding and a Care plan (which may already be part of patient notes rather than a separate section to save time). This should be followed by the clerical staff issuing an automatically generated letter summarising the clinical encounter and pharmacy dispensing the medication issued above.

It is unlikely to make EHRs an attractive prospect in India if clinicians are asked to pick and choose disease wise check boxes, move through dozens of screens and mouse clicks. It simply won’t work!

PTS a Modular EHR perfect for the Indian Hospital and Doctor:

The way we have designed the Patient Tracking System Electronic Health Record is to ensure all the above factors are catered for. We have considered an evolving iterative modular design. If a given Doctor is not interested in certain features or modules, we simply switch them off to make the EHR streamlined, simple and easy to follow for them. On the other hand an Academic setup in a Teaching Hospital may be keen to use more of the modules to drive Research. Corporate Hospitals may be keen to use clinical audits and make practice safer by adding clinical decision support tools to make practice safer to reduce liabilities through clinical errors.

Read more about our easy to use intuitive modular EHR workflow for doctors in India 

Future Ready EHR for ‘Modicare’:

Our vision for the Patient Tracking System Electronic Health Record and its use in India has the future in mind. From linking to ADHAR to working with Insurance companies or the Ayushman Bharat tariff’s, the system can scale up or down as needed.

Get in touch to find out more or collaborate | Browse through our Security Architecture and compliance with legal standards for EHR in India

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Dr Adhiraj Joglekar