Govt push, regulation aid EMR transformation

Full integration of electronic medical records (EMR) between the public and private health sectors can only be achieved with legislation and "top-down" directives, according to an industry observer.

Irving Tan, general manager for Singapore, Malaysia and Brunei at Cisco Systems, told ZDNet Asia in an interview that the technology "is there", but because of legal complexities and commercial interests, transformation of patient records in the region is not happening as quickly as it ought to.

"[Private practitioners] probably would not to want to move their records to the central depository because that's how they get patients to go back to them," he explained. "They are in a way business people or entrepreneurs."

Governments, on the other hand, oversee public healthcare systems and can enforce sharing of records within these ecosystems, Tan noted, adding that a centralized system helps to improve cost efficiencies in healthcare and has the ability to deliver more cost-effective services.

"I think the challenge is that how do we get one central EMR depository to enable total visibility of a patient's history between [the] public and private sectors. That's a regulatory issue governments have to solve," Tan said.

According to the Cisco executive, even if disparate patient data systems persist, cloud computing can help address the gap. This is achieved by federating the different clouds, such that information can be shared as long as there is appropriate governance and security in place.

Tan said: "That might be a transition that [the health sector] might eventually lead to, kind of a 'nirvana state'. I think that will be a more tangible and practical solution which the private sector would be more prepared to go to."

However, legal issues will still have to be ironed out, he noted. Tan questioned: "What if something goes wrong in a diagnosis, where does the liability lie? Does [intervention through telemedicine] count in the court of law as a legally-binding diagnosis?"

"I think why the migration is a bit slower is because the regulation hasn't caught up with the technology, and governments are still trying to figure out how to react," he pointed out. "If it catches up, then we'll see [EMR] take off in a rapid manner."

Countries such as Singapore, Malaysia and Hong Kong have started the EMR and electronic health records (EHR) transformation years ago. While none are fully transformed, some including Singapore, can be considered to be at the forefront of the journey, he said.

Tan added that it is difficult to put a timeframe to the digitization of healthcare, as needs and priorities are not the same across countries. For some, it may be EMR; others might focus on the digitizing of x-ray images or telehealth.

"For example, in India and Australia, the challenge is how to effectively serve communities living in rural areas, whereas in Singapore, it's about lowering the cost of healthcare and delivering more efficient services," the executive explained.

IT booster for healthcare
While healthcare needs and trends differ from country to country, technology has on the whole improved and simplified the way diagnosis is carried out, noted Tan.

The PaX system, which allows diagnoses of x-rays to be carried out offshore in places such as India, is one such example, according to Tan. The system, he said, has been proven to contribute to a higher quality of patient care.

"The turnaround time for x-ray diagnosis is now down to four hours from the previous two years," he noted. "The specialists in India are so attuned to the nuances that they come up with top quality reports efficiently."

Technologies gaining popularity in the enterprise are also making their way to the medical field. Cisco, said Tan, has partnered Apollo Healthcare in India to provide videoconferencing diagnosis in rural parts of the country, where medical services are scarce. By tapping on a PC-based application and wireless connectivity, doctors are able to examine patients and read their vital stats, bringing down the cost of diagnosis down to just US$1, he explained.

The videoconferencing diagnosis is also used at Cisco's headquarters in San Jose in the United States, on days the resident doctor does not visit.

In countries with ageing populations, such as Singapore, the use of technology is about reducing the burden on hospitals and polyclinics, and not "choke up" institutions with patients seeking diagnosis for minor repetitive ailments, Tan pointed out.

"For more developed countries like the U.S and Singapore with steady bandwidth in homes, tele-diagnosis becomes a reality. Instead of the patient going down to neighborhood GP (general practitioner), you can reach [virtually] a nurse or doctor who can then do a preliminary diagnosis, and then determine whether the case needs to be escalated," he said.

E-records more efficient with cloud
IT, according to Tan, is now regarded as a major element in healthcare sectors around the world, and the transition has been significant over the years.

Moving forward, cloud computing will be a key technology governments are looking to, as they push ahead to digitize records and move toward more cost-efficient healthcare operations, he said.

However, organizations need to pay attention to the security aspect of a health cloud, as they are dealing with sensitive patient information, said Tan.

"[Cisco has] to work together with partners to make sure the level of redundancy and robustness in terms of what we're doing from a security perspective, is aligned with their expectations and I would say this is very, very high on their agenda."