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BEYOND ELECTRONIC MEDICAL RECORD

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Rajiv Sikka, Head IT, Medanta- The Medicity Hospital,,

In inter-connected seamless world of immediacy and viral communications, all data is increasingly digitized. In an intense, critical and dynamic sector like healthcare, Electronic Medical Record (EMR) helps continuity and optimizes patient care. It achieves this by sharing information across caregivers (hospitals, lab, pharmacy etc.) and as a foundation for nation-level health registry; essential for effective execution of various public health programs. Notwithstanding its salience EMR will continue to have adoption challenges for multiple reasons: ROI, change management, lack of technical resources, non-standardization, inter-operability etc. With recognition of its advantages EMR adoption has increased significantly. It now has to rise to a viable scale while addressing issues of further optimization and clinical utilization. Even as EMR struggles to scale, the market is changing fast. The next phase of IT in healthcare taking shape is Beyond EMR (B-EMR).
Before we go into B-EMR, let’s understand what an EMR is. EMR, according to me, is fundamentally a system of records around basic work-flow between caregivers. It replicates existing processes into digital world with different degrees of automation, reasonable process optimization and operational MIS on top of it, which otherwise is labor intensive and prone to error. B-EMR is transformational technology for enabling new ways of doing things, doing more with less – more proactive, more productive & more value. The comparison between EMR and B-EMR is akin to Foundational Vs Transformational technologies. In the field of healthcare, there are few areas where IT led disruptive transformation is expected, such as:


Tele-medicine: Why should the quality of care you receive depend on your geographical location? There are enough statistics on current and emerging trends in tele-medicine usage pattern across geographies in terms of market size, consult volume, mobile penetration, advancement in connected biomedical devices etc. On the other hand, there are enough differences of opinion because of challenges like patient experience, doctor adoption, accessibility, lack of centers, quality of connectivity, setup cost etc. However, at the same time, there is a unanimous agreement that in the near future, telemedicine would be an important channel for healthcare delivery. In a country like India where accessibility to a doctor is a still a distant reality, telemedicine is the right platform to achieve the desired goals in primary health and continuity of care. Available platforms already have growing tractions for second opinion (after patients getting their first consult on Google).

Mobility: In sync with AAA – (Any time, Any device and Any place), mobility will help clinicians take well informed decisions based on complete patient history and this flexibility of AAA would provide the right stimulus in adoption of EMR. For patient (read customer), mobility provides freedom to digitally share their medical records and with that comes the right to choose their caregivers.

AI using Big Data & IoT: There are many enablers of Big Data and IoT in healthcare industry. Foremost amongst these is the availability of data itself through internet connected bio-medical devices, increased storage capacities, enhanced computing and rich-self-service visualization techniques. For ICU it is critical to monitor and analyze various vital signs almost one per minute basis and analyze in real time. Therefore, it is logical to automate by allowing devices to record data and display information independently. This is nothing but medical IoT (Internet of Things). There is no dearth of examples on how IoT and Big Data can dramatically improve patient care, amplify efficiencies and reduce costs of delivery. These applications may be in the area of ICU supervision, remote patient monitoring, chronic disease management, predictive surgical outcomes, preventive healthcare etc.

Virtual Reality (VR): Training and learning on cadavers is not effective and Dronacharya was only for Pandavas. Although VR usage is at an infancy stage in healthcare industry, it has the potential to train many Ekalavya. Pre-operative case planning is a function of enriched experience of individual surgeons. Needless to say, this skill is not truly scalable and at times, may not be precise enough for complex surgeries. With the help of VR, realistic and relatable training modules based on surgical scenarios can be developed. The risk-free customized virtual surgery modules would certainly help doctors to practice better. There are numerous applications of VR in healthcare for training nursing and paramedics on realistic immersive 3D models made to scale or on simulationbased scenarios like disaster management. Amongst the above, mobility and tele-medicine are relatively mature technologies and have potential to disrupt the way in which healthcare would be delivered in country like India. The other technologies are much diversified, vast and have different usage applicability. They have different degrees of evolution but few common characteristics like complexities and volume of the data with complex patterns. That’s the pattern which the above technologies promise to solve. Not many industry verticals other than healthcare can boast of having the availability of such huge volumes of data and defined use cases. Even though every aspect of business is prone to disruption or getting disrupted but it is still too premature for healthcare. In the near future, both EMR and B-EMR will co-exist. At the same time, with exponential advancement in above transformational technologies, a drift will happen from EMR to B-EMR, thereby laying the foundation for healthcare industrialization, if not for the complete spectrum, surely for primary healthcare.

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