Any person who walks into a hospital for treatment of a problem, big or small, would want efficient and effective care and transparent dealings with the hospital. These two parameters are increasingly becoming the ones on which hospitals measure themselves. A recent deployment of a state-of-the-art Electronic Health Records system at Max Healthcare Ltd., a well-known hospital chain in the Delhi National Capital Region, underscores this point.

"The EHR project was conceived with two major objectives," said CIO Neena Pahuja, in an interview with CTO Forum: "the first is quality of care and the second is continuity of care, which again dovetails into the quality of care. These are probably the reasons that most hospitals world wide go for EHR," she said. There is also an important consequence of achieving these two objectives, and that is charging patients right. This also helps the TPA (third-party administrator of insurance, for instance) and this is a reason, for instance, why in the U.S. there's a lot of pressure on hospitals to implement EHR because the insurance companies connect a lot with the EHR.

What is EHR

It starts off from the point a patient seeks an appointment. The person may then get appropriate treatment either as an outpatient or staying at the hospital and the EHR captures every step of the journey. Some important information that might be needed for follow ups is also captured. The information capture is exhaustive, from previous treatments, medications, alergies, medications that the patient shouldn't be taking and under what circumstances and so on.

Take the case of a person who being treated for a particular type of heart disease. If the same patient needs, say surgery to treat a different problem, some of the medication being adminstered for the heart disease will have to be stopped. The EHR captures all this information ensuring that it is available. This is how it facilitates 'continuity of care', giving doctors comprehensive information on what has happened so far, so that can they can chart the correct course of future treatment.

Similarly, in the case of a pregnancy, the availability of information on the progress of the baby from conception to birth along with the medical history of the mother ensures better quality of care. The EHR allows the parents of the child and the hospital to keep track of the child's development as well, ensuring vaccination schedules are adhered to, for example, and so on.

Right Medication, Right Patient, Right Time

From the patient's perspective, the EHR also captures information on allergies, for instance. On the hospital's end, the EHR is used to store all available information on generics, dosage, any known allergies that have been reported in connection with those generics and so on. The system then points out, not in all cases but in many cases, any instances of likely allergies or wrong dosage and so on using the base data that has been fed into it.

All this helps ensure "the right medication for the right patient at the right time," Pahuja said. "I'm sure you've seen a lot of hospitals have gone in for bar-coding of medication." At Max, wherever the system is hooked to the EHR, there are two bar codes. One for the brand, say Crocin, and another for the generic, paracetamol. "We actually now store medication from generics, and of course the brands also there" which brings in a lot of efficiency in the system, she said.

Keeping track of these helps in easily monitoring which medication was given to which patient at what time. Every patient in the hospital will have a unique ID assigned to the patient and the barcodes of the medication given to that patient will get associated with that ID. When a doctor prescribes a particular medicine to be administered at a particular time, the nurse after scanning the bar codes of the patient's unique ID and the medicine will get an alert if the time isn't within one hour of the time at which the medicine was meant to be given. "This kind of quality checks are built in," she said.

In-built Quality Checks

The EHR enables a one-window information of any given patient's care at any point in time, and helps clearly bring out how a patient is responding to the prescribed regime. This is the basic system that some of the forward looking hospitals across the globe are trying to put in, because it brings in transparency of care. It also makes the doctors and nurses more accountable. They sign off every document, and they look for every reaction before they sign off.

Indirect benefit for the patient-customer is that the EHR ensures that the charges are right -- no duplicates of any tests, no wrong medications are administered. The TPA now knows what is to be done almost immediately and the patient knows clearly why a doctor is asking for a particular test. This would also enable the faster approval of health insurance claims.

In addition to the PCs that doctors have, there are also laptops-on-wheels trolleys that have been further customised with the addition of bar-code scanners, a pull-out shelf for the keyboards, a sanitised hardtop that ensures infections don't spread from one patient to another. These trolleys also allow the doctors to view images access the EHR using the hospital-wide wifi and so on.

Quantifiable Benefits

The EHR went live in August and in so far four hospitals have become part of it, including three new hospitals that the chain started since. While the main objectives of quality of care and continuity of care are being met by this implementation, Pahuja expects that there will be some quantifiable financial benefits as well. For one, she expects that the project will eventually lead to a lot of savings in paper. "We are seeing a drastic reduction in paper," she said.

For the patients, this would mean significantly reduced waiting periods for the discharge processes to be completed, for example. In some cases, the streamlined quality and continuity of care might even cut down the number of days the patient needs to stay in the hospital itself, improving the hospital's "average days of stay" record.

Pahuja's team has spent approximately 300 sessions on training the doctors and other personnel in using the EHR. While the flagship hospital at Saketh needed change management handling, the new hospitals started with the EHR from the word go. "The doctors all like it," she said. The EHR was implemented by Dell Inc.'s IT services team and Max Healthcare used an open-source product called WorldVistA, that Pahuja said has been customised for Max Healthcare's specifications, including HIPAA compliance.

Soon, Analytics

In the near future, the hospital will continue to add more systems to the EHR. One such project that will be integrated soon is a Radiology Information System that will use a speech-to-text software program and make a specialists' observations and dictated reports available within a matter of minutes. The integration with the EHR also means that the text version will be available to any other specialists that a patient needs to consult very quickly.
In the coming months and years, the EHR, integrated with several other systems may also allow Max to start looking at trends in instances of various diseases, their causes, the pre-disposition of various categories of people in terms of age, gender, diets, and perhaps even socio-economic factors and so on. This will be done to the level where doctors will work out which medicine is better for a person based on whether he is a chapati eater or a rice eater. "That's the next step, analytics," Pahuja said.