India and developing world can avoid mistakes of the West when implementing Electronic Medical Records
UK started venturing in to electronic patient records in late 90’s, most Trusts rolled out systems in out-patient services by 2005, though use of electronic medical notes on the inpatient wards is still in its infancy in many hospitals in UK.
A number of lessons need to be learnt from the billions that the NHS has wasted. The provider market is limited to a few players and this virtual monopoly equals lack of innovation. There has been an obsession over safeguarding all NHS data in a private network, the N3. This means increased costs and ironically, whilst striving to keep data safe, exposes the entire data set in one go!
The idea of a National Spine and all patients and vendors being connected to it is Utopian, in reality, only now at considerable additional costs has data started to become portable across services through use of APIs that connect a GP application to that used by a Hospital.
A lot of the digital patient or health record vendors have over time produced systems that are not agile, not intuitive and time consuming and very likely duplicate efforts. The workflow has often been envisaged by arm chair experts and Tech teams rather than front-line staff with resultant poor user interfaces.
For instance, there is little use of an electronic patient record if the following can’t be achieved with it, these are the actual drawbacks of systems in place in UK after millions of pounds worth of investments.
- No appointment portal for patients
- Limited or non-existent E-referrals for GP or partner agencies to use
- Multitude of disjointed forms and templates that duplicate and waste clinical man hours.
- No or limited automation, it is not good enough to provide a repository for entering height and weight of a child if percentiles are not calculated instantly. It is pointless if patients have to be provided paper-pen questionnaires, for the responses to then manually entered and at the end of the EPR/EHR failing to provide automated scoring. That means creating and maintaining 100s of excel sheets to do the job alongside.
- Lack of quality clinical decision aids built within the system or at the other end of the extreme creating hundreds of tick boxes that make the use of electronic care records a nightmare for the most tech savvy clinicians. The Bawa Garba Case where a doctor took the blame for all that went wrong is a prime example, the IT system was broken, it did not automatically flag up abnormal blood results unless someone entered patient notes (when ideally a doctor should get a notification on their smart device prompting them to look at the results) and the consultant many miles away will have no access to his junior doctor or patient records via a smart device (not too much to expect in this day and age).
And the above is a shortlist of items, but it is these issues that made the transition from paper notes to electronic care records a real challenge.
India and other BRIC countries are at a point where with growing economies, they can now fund IT innovation in Healthcare Sector, hopefully the same mistakes will not be repeated.
Read more about how smart EHR could help reduce harm in the context of the Bawa Garba Case
Dr Adhiraj Joglekar