Electronic Health Record: Maximizing Utilization

Digital health electronically connects the points of care so that health information can be shared securely to help deliver safer, better quality healthcare. The broad scope of Digital Health includes categories such as mobile health (mHealth), health information technology (IT), wearable devices, telehealth and telemedicine, and personalized medicine. Digital health is about electronically connecting the points of care so that health information can be shared securely. This is the first step to understanding how digital health can help deliver safer, better quality healthcare.

A cornerstone of digital health is EHR or Electronic Health record that is a digital version of a patient’s paper chart. EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users. While an EHR does contain the medical and treatment histories of patients, an EHR system is built to go beyond standard clinical data collected in a provider’s office and can be inclusive of a broader view of a patient’s care. EHRs can:

• Contain a patient’s medical history, diagnoses, medications, treatment plans, immunization dates, allergies, radiology images, and laboratory and test results
• Allow access to evidence-based tools that providers can use to make decisions about a patient’s care
• Automate and streamline provider workflow

Automatic integration of EHR systems and intravenous medication infusion devices equipped with dose error reduction software (drug libraries), is termed intravenous (IV) interoperability. This should serve as the goal toward which all healthcare systems work to maximize patient safety.

Standardizing healthcare information technologies along with regulatory reforms, can be the primary drivers of increased EHR adoption in India. Healthcare providers, however, need to expand their focus beyond simply looking for incentives. To realize the full benefits that EHR solutions can deliver, medical organizations must carefully plan their EHR implementation to achieve optimum utilization. Only then will these organizations achieve the improvements they desire, and ultimately realize a positive return on their technology investments.

The Ministry of Health and Family Welfare has already notified the Standards to be used for exchange of health information. The second edition of the standards was notified in December 2016. Further, an Integrated Health Information Platform (IHIP) is being set up for exchange of health information in an interoperable manner. Detailed and up to date information about these developments can be obtained from the EHR Standards Helpdesk of the National Health Portal: https://www.nhp.gov.in/ehr-standards-helpdesk_ms

The National Health Policy-2017 advocates extensive deployment of digital tools for improving the efficiency and outcome of the healthcare system. The policy aims at an integrated health information platform or system which serves the needs of all stake-holders and improves efficiency, transparency, and citizen experience. Delivery of better health outcomes in terms of access, quality, affordability, lowering of disease burden and efficient monitoring of health entitlements to citizens, is the goal. Establishing federated national health information architecture, to roll-out and link systems across public and private health providers at State and national levels consistent with Metadata and Data Standards (MDDS) and Electronic Health Record (EHR) Standards, will be supported by this policy. The policy suggests exploring the use of “Aadhaar” (Unique ID or UID) for identification. Creation of registries (i.e. patients, provider, service, diseases, document and event) for enhanced public health/big data analytics, creation of health information exchange platform and national health information network, use of National Optical Fiber Network (NOFN), use of smart phones/tablets for capturing real time data, are key strategies of the National Health Information Architecture. The policy advocates scaling of various initiatives in the area of tele-consultation which will entail linking tertiary care institutions (medical colleges) to District and Sub-district hospitals which provide secondary care facilities, for the purpose of specialist consultations. The policy will promote utilization of National Knowledge Network (NKN) for Tele-education, Tele-CME, Tele-consultations and access to digital library.

The National Health Policy 2017 of India states that recognizing the integral role of technology (eHealth, mHealth, Cloud, Internet of Things or IoT, wearables) in the healthcare delivery, a National Digital Health Authority (NDHA) will be set up to regulate, develop and deploy digital health across the continuum of care.

Implementing an EHR is not a straight-forward process, and a “one-size-fits-all” approach is ineffective, since numerous variables exist in every practice. An optimized implementation will make the difference between an EHR that drives improvements in efficiency and care delivery, versus an EHR that is abandoned or even replaced.

The best practices for EHR implementation usually involve the following areas:

• Securing physician leadership
• Setting realistic expectations
• Adequate and appropriate Documentation
• Acceptance of evolving staff roles and responsibilities

Cost components to consider when budgeting for an EHR include:

• Software licensing (outright purchase, leasing and/or monthly subscription fees)
• Hardware expenses, depending on the age or capabilities of current equipment
• Implementation
• Configuration and customization
• Training
• Support and maintenance
• Potential lost productivity that impacts revenue during implementation, training and initial use of system

However, for an EHR to be successful it must maximize clinician efficiency. An emphasis on performance (availability and speed) will have to be in place to make EHRs successful. It must be remembered that EHRs are not stand-alone systems but are ‘systems of systems’.

While the long-term benefits of EHRs are being evaluated, patient portals are a beacon of encouragement. As a single component of or complement to an EHR that helps achieve better care, better health, and reduced costs, the patient portal can drive significant value. Optimally deployed with self-service identity management tools, health systems can magnify the importance of their patient portals to enhance patient loyalty, increase enrollment and utilization of targeted patient groups, and increase the quantifiable clinical and financial benefits for patients and providers alike.

Health Information Management (HIM) professionals are well trained in the latest information management technology applications and understand the workflow in any health care provider organization. Health Information Managers are vital to the daily operations management of health information and EHRs. They ensure that Data Quality is maintained, by applying the principles of Change Management and continuous capacity building through education and training. They ensure that the health information and records of a patient are complete, accurate, protected and meet the desired and stipulated medical, legal and ethical standards. Therefore, it must be made mandatory to appoint an adequate number of health information managers, according to the size of the healthcare organization, to ensure safe and smooth adoption of digital health in India, leading to informed and safer healthcare delivery.

At International Institute of Health Management Research, New Delhi, Health Information  Manager in MBA, are well trained in the latest  technology applications and understand the workflow in any health care provider organization. The admission process for this course has started. Health Information Managers are vital to the daily operations management of health information and EHRs. They ensure that Data Quality is maintained, by applying the principles of Change Management and continuous capacity building through education and training. They ensure that the health information and records of a patient are complete, accurate, protected and meet the desired and stipulated medical, legal and ethical standards. Therefore, it must be made mandatory to appoint an adequate number of Health Information Managers, according to the size of the healthcare organization, to ensure safe and smooth adoption of digital health in India, leading to informed and safer healthcare delivery.

Posted By :-

Prof. Supten Sarbadhikari