Digital medical records provide critical backup

Summary:Following Japan's 9-magnitude earthquake, experts underscore need for countries to digitize citizens' healthcare records. Singapore gives update of its own implementations.

The wide-scale destruction caused by the recent north Japan earthquake and tsunami has highlighted the importance of electronic health records (EHR), with industry watchers urging for countries to digitize healthcare data.

According to IDC's Health Insights research manager Janet Chiew, the earthquake revealed compelling benefits that EHR can bring to citizens in situations when large scale medical and rescue operations are required.

"Imagine the enhanced effectiveness and savings in resources if rescue parties and medical teams are aware of the profile of people in danger, put on standby the necessary equipment and drugs for those chronically-ill, and quickly identify those with special medical conditions upon rescue. This can be possible if the information is made available via a national EHR (NEHR) [system]," Chiew explained in an e-mail.

With hospitals and clinics destroyed, records of the sick and elderly may be ruined, and this can lead to greater medical and logistical complications for those affected by the disaster. According to an EHR online forum, author Katherine Rourke shared that while Japan has a health information exchange (HIE) strategy, it is still immature.

"EMR (electronic medical record) coverage is patchy, though like here in the United States, is on the upswing. Research interest is high, in fact, medical informatics specialists there have developed their own clinical data exchange format, the Medical Markup Language. However, health data digitization and sharing is still in its early stages, or so it seems from the reading I've done," Rourke said. She also suggested that a robust HIE system would serve as a good backup in case of widespread infrastructure damage.

EMR typically refers to a person's healthcare information and profile generated by visits to a doctor, whereas EHR is defined as the aggregated health information of a patient such as demographics, medications and medical history that may be shared by multiple providers and caregivers.

More strategic, less IT
Governments in the region have started or are undergoing the EMR transformation, with an IDC prediction early this year noting that EHR will remain the "top priority" of healthcare providers across the Asia-Pacific region, due to increased budgets and greater revenue from medical tourism.

Chiew said: "Creating a national EHR is a mammoth task that requires not only large amounts of financial investments from the government, but also from private healthcare providers. Policies and technology play critical roles in ensuring fast and unique identification of people whilst offering privacy protection, and hospitals and clinics with various electronic medical records and systems are able to share the patient's records seamlessly through common standards," she said.

John Vidas of Accenture's for Asia-Pacific health industry lead, concurred, pointing out that EMR planning and implementation must be a strategic initiative, and less of an IT one.

"Having the passion, influence, engagement and attention from a hospital's leadership [team] from the outset, was consistently cited by our study participants as a success driver," Vidas told ZDNet Asia in an e-mail interview, referring to a CIO survey Accenture recently completed.

Some of the challenges often encountered in EMR implementations included the fight for IT talent and extended length of time for project completion, he said.

"Most of the healthcare systems in our benchmarking study underestimated, by nearly 100 percent, the time and costs associated with implementing advanced EMR functions, including clinical order entry, nursing and physician documentation, clinical decision support and barcoding medication.

He quoted the example of a 500-bed hospital where the average EMR implementation is estimated to take "roughly two to five years", subject to factors such as the target market's implementation strategies, government regulations, local trends and maturity of healthcare IT.

Singapore almost there
Singapore started its EMR journey in the late nineties and is two years away from full implementation, according to Chong Yoke Sin, CEO of Integrated Health Information Systems (IHIS), the IT arm of the nation's Ministry of Health (MOH).

Chong told ZDNet Asia that the country's health institutions are "well on their way of going paperless", with some of the polyclinics completely "electronic".

"The aim for EMR is to actually go paperless, chartless, filmless and scriptless. So far, I think we've achieved by and large maybe 50 percent of the target. We also do not process [x-ray] films anymore, everything is viewed on screen," she shared.

MOH in 2004 began linking EMRs between Singapore's clusters of hospitals and polyclinics, which is now fully established. The government is also in the final stages of its NEHR implementation which will be completed by next month.

This is where the final piece of the pie, encompassing general practitioners in private practice, will be connected.

Chong explained that beyond EMR, the next phase of Singapore's e-healthcare "journey" involves the development of telehealth, where patients are given tools to electronically monitor their condition, such as the Web app for rheumatoid arthritis patients which was launched earlier this week.

With the digitization of medical records, MOH is also looking to cloud computing for greater cost savings and computing power optimization, she revealed, adding that the sector's e-mail messaging system is among the first to be migrated.

"There are privacy issues with [putting] medical records on a public cloud, which is why we're making a private cloud for medical records," Chong said. "Over time, when security aspects of the cloud are improved, we might then actually explore the possibility of going hybrid which definitely will generate better economic benefits than the private cloud."

She added that the ministry will be introducing its own cloud for healthcare services, which will be separate from the government's cloud strategy which was recently announced.

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