Feb 27, 2014
IMPLEMENTATION OF ELECTRONIC MRD- A FEASIBILITY STUDY IN A TERTIARY CARE HOSPITAL
Exactly, as shared by one of the follower of my blog for use of students all over- Thanks a lot! if you wish I will put your name here any time!
As the medical care gets more and more complex and as the stock of
information enlarges the physicians need new technologies to help them cope and
be more efficient. This makes essential the use of information technology and
need for a digital to allow capture of patient data that can then be processed
and mined for insights into better treatment for patients.
With
the many advances in information technology over the past 20 years,
particularly in healthcare, a number of different forms of electronic health
records (EHR) have been discussed, developed, and implemented.[1] The electronic medical record (EMR) is the tool that promises to provide
the platform from which new functionality and new services can be provided for
patients.
Around the globe, there
has been a significant improvement in the healthcare industry standards and use
of various tools to define quality. Quality of patient information is one such
tool which helps the health care organizations provide excellence in the
industry. But, there are many misconceptions about various terminologies and
concepts of use of information technology and electronic medical records.
Electronic Medical Record: “An application
environment composed of the clinical data repository, clinical decision
support, controlled medical vocabulary, order entry, computerized provider
order entry, pharmacy, and clinical documentation applications. This environment
supports the patient’s electronic medical record across inpatient and
outpatient environments, and is used by healthcare practitioners to document,
monitor, and manage health care delivery within a care delivery organization
(CDO). The data in the EMR is the legal record of what happened to the patient
during their encounter at the CDO and is owned by the CDO” by HIMSS
A feasibility study is an evaluation and
analysis of the potential of the proposed project which is based on extensive
investigation and research to give full comfort to the decisions makers.
Feasibility studies aim
to objectively and rationally uncover the strengths and weaknesses of an
existing business or proposed venture, opportunities and threats as presented
by the environment, the resources required to carry through, and ultimately the
prospects for success.
In its simplest terms,
the two criteria to judge feasibility are cost required and value to be
attained. As such, a well-designed feasibility study should provide a
historical background of the business or project, description of the product or
service, accounting statements, details of the operations and management,
marketing research and policies, financial data, legal requirements and tax
obligations.
Till late fifties in
India, there was no awareness among the hospital clinicians as well as
administrators and usually the Medical records departments that have come up
were not planned as a part of total health care.
Various Organizations
face various problems with medical records they are:
- Incomplete
records, for which the physicians are asked to complete causing
duplication of work
- Inadequacy
of space, causing the decentralized storage of records
- Frequent
requests of changing patient’s name
- Loss
of records
Despite of above problems
been faced for a long time there is no Information technology coming in, in
spite of the availability of many efficient Electronic medical records systems.
It was thus decided to conduct a study of the medical records department of
ABC a hospital, to understand the barriers and facilitators of
Implementation of EMRs.
While it is important
to determine what is “in the EMR” it is also critical to understand what is not
considered part of the EMR. Gartner has put forth a model for the Healthcare
environment which contains all of the IT systems needed to run healthcare
organizations.
AIM
AND METHODOLOGY OF THE STUDY
The study was intended
to find the feasibility of Electronic Medical records in a tertiary care
hospital.
The study was based on
the Observations of the policies and procedures, the cost estimation and Closed
End Questionnaire from the medical professionals with the sample size of 354.
LITERATURE
REVIEW
HEALTH INFORMATION
SYSTEMS
Health Information
Systems are designed to integrate data collection, processing, reporting, and
the use of information necessary for improving the effectiveness and efficiency
of the health service through better management at all levels of health care
(WHO, 2000).
Medical records institute defines five distinct stages [Figure 3.2] of
health care information system towards the development of true
Electronic Health Record (EHR) (Weagermann, 1999) in Gash (1999). [15]
Definitions:
The market has confused
the electronic medical record (EMR) and the electronic health record (EHR). The
NAHIT has produced the following definitions for EMR and EHR and PHR:
EMR: The electronic
record of health-related information on an individual that is created,
gathered, managed, and consulted by licensed clinicians and staff from a single
organization who are involved in the individual’s health and care.
EHR: The aggregate
electronic record of health-related information on an individual that is
created and gathered cumulatively across more than one health care organization
and is managed and consulted by licensed clinicians and staff involved in the
individual’s health and care.
PERSONAL HEALTH RECORD:
An electronic, cumulative record of health-related information on an
individual, drawn from multiple sources, that is created, gathered, and managed
by the individual. The integrity of the data in the ePHR and control of access
to that data is the responsibility of the individual.
DIMENSIONS
OF EMR:
EMR is more than just electronic storage of
records/ data. It is a system. There are 10 DIMENSIONS OR CORE CAPABILITIES
OF EMR as defined by Gartner
 |
| 10 Dimensions of EMR , Fig 3.3
CHALLENGES IN
IMPLEMENTATION OF EMR:
A. Transition
(Paper Chart to Electronic) – Hybrid
B. Total
Cost (Return on Investment)
C. Integration
with the Workflow
D. Usability
(Clinicians)
E. Usability
(Nurses)
F. Interface
with rest of the system
G. Interface
with Devices
H. Down
time management – Availability, Disaster Recovery
The above challenges
can be overcome by a planned and effective implementation
IMPLEMENTATION OF EMR
American Society Of
Cataract And Refractory Surgery and American Society Of Ophthalmic Administration
have stated Five Steps of Implementation:
1.
Advance preparation
2.
System selection
3.
Implementing right fit
4.
Training/ maintenance
5.
Go live (continuous improvement)
ADOPTION SCENARIO OF
ELECTRONIC MEDICAL RECORDS: India
Majority of the
hospitals in Asian countries such as India, China, Thailand, Malaysia and
Indonesia are still in the early stages of IT adoption. These hospitals are far
behind in terms of IT adoption when compared to USA." said SourabhKankhar
Research Analyst, Asia Pacific Healthcare Practice, Frost& Sullivan.
Reasons of faster
adoption in West than India are perhaps based on certain specific factors
dominating the Western healthcare scene, such as increased patient awareness,
new government initiatives encouraging EMR, high penetration of computers, new
product innovations, economic pressures on healthcare organizations and
increased legal compulsions for greater accountability and well-maintained
records.
The EMR market is a
fast developing market in India. Barriers of EMR Adoption in India are: most
importantly lack of awareness among medium and small scale providers about the benefits and advantages.
Resistance to adoption are lack of compatible technology with existing systems
and lack of user friendly interface, high cost of implementation, long
implementation process, the decrease in productivity during implementation,
vendors lack domicile knowledge in healthcare.
GLOBAL MARKET:
Accenture conducted a
study of leading health care software, hardware, and services companies to
gauge the attractiveness of eight international electronic medical record (EMR)
markets of considerable size and EMR maturity. Those markets include Australia,
Canada, France, Germany, Japan, The Nordics, Spain and the United Kingdom (UK).
Other large markets— namely, India and China— were not studied due to
conflicting opinions of overall EMR maturity.
The market is expected
to grow at a rate of 6.6 to 9.7% across North America, Europe, Latin America
and Asia Pacific. The global market is expected to be $19.7 billion in 2013.
Asia Pacific’s EMR
market is expected to grow at 7.6 percent Compound annual growth rate (CARG)
from $2.3 billion to $2.9 billion (which is highly dependent on the growth rate
of INDIA and CHINA) as compared to North America with highest growth rate of
9.7% CARG from $7.4 billion in 2010 to $9.8 Billion in 2013. The acceleration
in the market is due to ARRA incentives and penalties.
Europe, Africa, and
Latin America will grow at 7.6% through 2013 driven by government incentives.
The study states that
there are four primary forces which have the most impact on EMR growth:
1.Emerging Markets:
Many emerging markets (for example, Malaysia, Thailand, Brazil, Russia, India
and China) and can potentially utilize innovative approaches such as
cloud-based solutions. The future of these markets will be largely dependent on
regulatory standards, government support and future trends affecting domestic
health care systems.
2.Government funding:
Government incentives (e.g. The United States’ ARRA incentives and penalties
3.Regional National and
multicountry integration
4. Labor Shortage: with
rapid increase of information technology in health care, there is expected
increase in demand of the clinically trained IT personnel and because of more
shortage of nurses in near future the need to have Electronic Medical Records
is definitively going to arise.
OBSERVATIONS:
1.
The Major problems with manual medical
records were identified to be:
· Delay
in patient care because of dispersed records.
· Multiplicity of form types used to document the patient
records.
2.
The awareness levels among the health
care workers was highest among health care workers with post graduates and lowest
among those with diploma holders.
3.
The Acceptance Levels of the EMR which
was seen among the health care providers (nurses and Post graduate doctors 75%
and 86% respectively) in the tertiary care hospital were seen to be 75% andmajority
of the health care providers are willing to take up the training.
 
1.
There was need to increase the
infrastructure to 25% of number of computers and 15 % of printers (keeping in
mind the security of patient information).
2.
Cost of Implementation:
Ø The
total health IT includes:
v The
initial fixed cost of the hardware, software, and technical assistance
necessary to install the system;
v Licensing
fees;
v The
expense of maintaining the system; and
v The
“opportunity cost” of the time that health care providers could have spent
seeing patients but instead must devote to learning how to use the new system
and how to adjust their work practices accordingly. Various studies have stated
that the productivity decreases by 10%
to 15%
v Social
costs: Risk of lost privacy because of such system and such situations can be
avoided by complying to the governmental standards in their respective
countries, also by providing the ability to track who accesses the patient’s
record.
Ø The
costs of implementing vary widely based on the:
v Size
and complexity of providers’s operations.
v The
extent to which the providers want to perform their work electronically.
v Differences
in the amounts and types of associated training and labor costs (for operating
the system).
The cost calculated was
Rs. 2,31,00,000 based on all the above factors.
There were few areas
where recurring cost due to increase in infrastructure increased (because of
cost of maintenance, increase in electricity expenses).
The areas of cost
saving were the decrease in the labor, the stationery, which was estimated to
be Rs.38,00,000
CONCLUSION:
If the patients’
records are made electronic the space used presently for paper records can be
used for other purposes. As MRD is in the OPD block various other services can
be provided.
The major problems faced by nurses and post
graduates with the present paper records are:
Ä Delay
in service delivery because of dispersion of records by 66.9% nurses whereas
86.1% of post graduates face this problem
Ä Multiplicity
of form types consumes their major time (65.9%) whereas (83%) post graduates
face this problem.
graduates
highly agree and agree that health care should devote time to the training
The
Capital cost of implementation of
EMR was calculated to be 2 Crore 31 lakhs .Once the EMR is fully functional the
expected cost saving can be somewhere more than 35 lakhs per year.
SUGGESTIONS:
v First
of all the users’ needs and problems should be identified and their acceptance
to change must be evaluated. Orientation is important at this stage.
v The
institution must ensure that the inefficiencies in the department must be
removed first then the implementation must commence.
v The
cost of implementation is very high so the implementation can be stepwise and
the costs can be divided into two financial years.
SUGGESTIONS:
v First
of all the users’ needs and problems should be identified and their acceptance
to change must be evaluated. Orientation is important at this stage.
v The
institution must ensure that the inefficiencies in the department must be
removed first then the implementation must commence.
v The
cost of implementation is very high so the implementation can be stepwise and
the costs can be divided into two financial years.
v The
dependency on vendor should be minimized thus vendor operated systems should be
avoided
v The
EMR should be easy to learn, understand, operate i.e. no requirement of opening
of multiple windows, which tends the user make mistakes.
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