Need for digitization of health records in private practice

Stethoscope and GlobeToday, doctors everywhere are trying to adopt newer technology to improve their clinical practices. Doctors want to improve communication between patients, hospitals, and their referral doctors. Some are utilizing scheduling and appointment software for online appointments, and some offer a dedicated helpline or SMS reminders for patients. Mobile apps and telemedicine are being used as well. Pathology labs and radiology clinics are now emailing patient reports to the patients and referring doctors.

Every practicing physician wants to ensure his/her patients’ satisfaction. The time spent by the doctor with his patient, as well as the clinic’s waiting rooms at the outpatient clinics testify to the patient experience. What’s more is that the doctor-patient ratio in India is quite low, so existing doctors are overburdened with the volume of patients and time constraints.

In India, private expenditure in healthcare is about 70% [1], so most patients seek private practitioners and private hospitals for their health advice and treatment. Nearly all of the health data of every Indian resides within the private clinics and hospitals. Hospitals are showing keen interest and have taken steps forward to digitize patient data. However, clinics are lagging behind, and paper records are still their choice method.

Every clinic or outpatient setting has 3 types of patients:

  1. Walk-in: first visit will take more time for history and examination
  2. Referred patient: first visit will take more time for history and examination
  3. Follow-up: examination and follow-up treatment

Every physician examines a mixed bag of patients every single day. It is impossible for them to remember each patient’s findings when he/she comes for a follow-up. As of right now, paper records are the only source of information during[s2If !is_user_logged_in()]…

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Consider these routine scenarios at leading private clinics:

Scene 1: Mrs. ABC called the orthopedician for a sprained ankle. The doctor advised pain medication, rest, X-rays, and asked her to see him in the evening. She got her X-ray done, and the radiologist told her that a copy of her X-ray and report would be emailed to the doctor.

Mrs. ABC visited the clinic as per the appointment and met the doctor. He asked for her X-rays, and she told him that the radiologist had emailed it to him. He had deleted the email after checking and wanted the X-ray for reference, and Mrs. ABC forgot to carry it.

This is a routine scenario where patient management gets delayed, so a document system for storage and retrieval is very important.

Scene 2: A patient is brought to a physician’s clinic with acute chest pain and the ECG shows myocardial infarction. The patient is then stabilized, thrombolysed, investigated and treated further.

This chain of events needs to be documented for future treatment of the patient.

Most of the private clinics in India do not have a clinical patient data management system or Clinic Information System (CIS) installed, which can store patient data for future reference and treatment.

The basic requirements of a system would be:

  1. Unique identification for each patient
  2. Clinical templates to record history
  3. Storage of all investigation reports (lab, radiology, etc.)
  4. Generate prescriptions and diet advice
  5. Scheduling appointments
  6. Referral management
  7. Creating patient reminders/alerts
  8. Billing

CIS records the following:

  1. Patient demographics and contact details
  2. Clinical history and examination, including allergies, past history, treatment details, diagnosis and treatment plan
  3. Prescription for medications and investigations
  4. Follow-up history

This basic system, once implemented, can later be enhanced to utilize the patient data repository for research and analytics. Initially, it is going to be a tedious task to record the patient data electronically, but it will streamline the work of the doctors at their private clinics. This system would significantly bring down medication errors and thus ensure patient safety.

Advantages of such a system:

  • Web-based patient records can be accessed anytime and from anywhere
  • No data loss, providing for better patient management
  • Better communication with patients
  • Ensure satisfaction for referral doctors
  • Ensure patient safety
  • Help doctors treating patients who travel to India under medical tourism

In developed countries, it has been observed that patient records are transcribed, or nurse informaticians maintain the records under the guidance of the doctors. This concept can definitely be implemented in India with our skilled workforce.

Cost analysis and implementation expenses for such a system will be clinic-specific. There are open-source software packages available in the market, which can be enhanced at low costs.

The Clinical Establishment Act, 2010 has also laid down standards for electronic health records in India. Indian government needs to take initiative in designing a system and make it available for private clinics at subsidized rates.

Clinical data documentation and maintenance of patient data is the future of healthcare, which will bring standardization and best practices.

AK Valimbe Dr.Ashwini Valimbe, Health IT Consultant, US and Indian healthcare domain. Expertise in health outcomes, EMR, Meaningful Use and Comparative Effectiveness Research. Current interests includes designing and implementation of simple tools for private clinics in India and physician education to adopt technology and transform healthcare.

References (click to show/hide)

  1. India.com Health. Economic Survey 2013: India’s healthcare spends among the lowest. Accessed 01/21/2014 at: http://health.india.com/news/economic-survery-2013-indias-healthcare-spends-among-the-lowest/


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2 Comments

  1. Dr. Kasim Kolakkadan
    Posted Mar 2014 at 6:18 am | Permalink

    when i came back to India after working in Saudi, UK, and Australia I was looking for an ideal Electronic medical record and didn’t find one for my private clinic. problems i faced are
    1- good one are costly for Indian scenario
    2- net connections are not reliable in rural areas
    3-the patient load is too-much and the time spend on each patient is very less
    4- As other colleagues are not using it so electronic communication to them is difficult

  2. Arun Kumbhat
    Posted Sep 2014 at 3:34 pm | Permalink

    Dr.Kasim, would be happy to speak to you.
    My e-mail is arun.kumbhat@gmail.com

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