EMR in the age of digital health

The electronic medical record is an integral part of patient management system and has been constantly evolving since its development in 1972. In today’s world of constant technological advancement, especially in the field of data storage and sharing, the form and format of EMR has considerably evolved.

The International Finance Corporation (IFC) held a panel discussion on 15th September 2020, as a part of their series focused on the private health sector in emerging markets, to discuss the potential of EMR (Electronic Medical Records), current challenges faced in emerging markets, and ways to integrate this with current systems used in hospitals.

The panelists consisted of Mr Cris Ross, CIO, Mayo Clinic, USA, Mr. Gilberto Guzman, Former CEO of Hospital Metropolitano Vivian Pellas, Nicaragua and Ms. Ifeoluwa Olokode, Head of Partnerships, Helium Health, Nigeria. Several insights emerged from this discussion and are summarized below

• Do not let technology be your master. Use it as your slave to achieve your objectives. We must manage the technology well to achieve what we want. One size does not fit all- EMRs in the US will be different from India and South America
• In emerging markets like Nigeria and others, less than 10% of the hospitals have implemented EMRs. Paper is the biggest competition. Low internet penetration, poor computer literacy and costs are other major impediments for large scale adoption
• Flexible pricing models for different facility sizes, pay as you go models will be required to be provided by EMR organizations. This would make it more economical for hospitals to adopt these systems
• Not every facility will require an enterprise level EMR. A modular based system should be offered by EMR organizations. However, do not build systems in silos. This will undermine the potential use of data and efficiencies

• Handholding, educating and training of hospital staff and doctors will be key for successful implementation and adoption of this system on a larger scale
• Regarding interoperability, the health system is currently not designed to, nor is willing to share patient information. Reporting formats, data collection, integration of platforms and other works are to be standardized
• HL7 FHIR (Fast Healthcare Interoperability Resources) based systems will see accelerated growth and drive interoperability. FHIR will be a game changer
• Technology will make it possible, but people will make it happen. We need to take people along for technology adoption
• Ensuring affordability of the EMRs in emerging market will be important. Flexible pricing structure for different facility sizes needs to be designed and offered. Cross subsidization across large systems and smaller facilities is another option. This could also be achieved through local government
  initiatives and funding
• Think global, act local for EMRs. Use international libraries like ICD 10 and others. Data should be transmittable for research and development. Standards should be global
• Finally, hospitals should be a combination of both digital/paperless and paper based for now. Some services can be completely paperless, but in some, it must be a combination. Hospitals should try to be paperless as much as possible and have a timeline for eventually going fully paperless

In India’s context, the adoption of EMR has been drastically low. This is due to several gaps in the system-lack of awareness & computer literacy, perceived high cost of implementation, lack of technological resources and complicated EMR interfaces,legacy issues to adopt new systems.The usage of EMR is limited to the big corporate hospitals in the metro cities and some select states and districts in India.

These challenges must be tackled head on, especially with initiatives like Ayushman Bharat presenting a valuable opportunity for building a person-centered health system. When fully implemented Ayushman Bharat will be the world’s largest healthcare program that is digitally driven. All signs indicate that it is India’s time toshow its digital savviness and its healthcare capabilities.

The hospital sector would be one of the most interesting opportunities to create value and impact. This opportunity will be for those organisations who will embrace technology and EMR will be integral to their technology platform.