Need regulatory framework to regulate use of EMRs: Dr. Rajendra Sharma, Medical Superintendent, Safdarjung Hospital

New Delhi  : We require a regulatory framework that mandates and regulates the use of EMRs (Electronic medical records) and other clinical applications including Hospital Information System (HIS), said Dr. Rajendra Sharma, a top official said at an ASSOCHAM event held in New Delhi on Wednesday, July 11 2018.
 
A vast majority of our hospitals and clinics still run on paper-based systems and have no centralized system to store medical records. National Policy for the same is also under consideration. Such systems are presently being adapted by larger central referral hospitals like Safdarjung Hospital and AIIMS, said Dr. Rajendra Sharma Medical Superintendent, VMMC & Safdarjung Hospital while inaugurating an 3rd Conference on Health Security for All.
 
The citizens of India will benefit from an integrated health information system across all states.  This system will aid in all aspects of healthcare planning, delivery, and monitoring, including disease surveillance, patient medical records, planning for human resources, continuing medical education, facility registration, and telemedicine initiatives. The same has also been envisaged as priority area in the National Health Policy 2017.
 
The first step in the process of technology adoption will be to capture all patient health information at the point of care, especially hospitals and clinics. This information may then be shared with health information exchanges where it can be accessed easily by doctors and hospitals. It will save duplication of tests, the associated costs and precious time, in instances where minutes can make a difference between life and death.
 
The next critical step is to ensure that the data is uniformly captured, interpreted and accessed by all those concerned. And, given the sensitive nature of patient health information data safety is the other vital concern, Dr. Rajendra Sharma.
 
Having discussed the merits of technological transformation in healthcare, the emerging challenges in Healthcare starting with access to specialist care in rural areas, skewed doctor–patient ratios, community social perceptive concerns apart from alarming increase in non-communicable diseases or NCD’s needs to be highlighted.
 
These problems in Indian health care system includes lack of trust, the modern society is progressively loosing the trust in the healthcare service be it the doctors, hospitals or labs. Part of this problem is due to increased costs which make a negative outcome doubtful and the other part is because of a significant part of healthcare delivery chain is under regulated, said Dr. Sharma.
 
Unfortunately people are also wary of government health institutions due to the large crowds and unmatched resources for the larger population base. Reducing the out-of-pocket expense on healthcare is likely to address this problem and we may see it in time with the roll out of the Ayushman Bharat – National Health Protection Misson of universal health insurance, added Dr. Rajendra Sharma.
 
The government wants to see more people come to its facilities, but this will require a fundamental shift in thinking. As it stands healthcare providers are not held accountable for a lot of their actions excluding the Doctors who are liable under the Consumer Protection Act. Introducing accountability into private and government healthcare will require a profound culture change. Respect for patients and a focus on results will not be easy to achieve.
 
Specific training in patient safety issues, making policy and implementation of patient safety standards is crucial to improving accountability.
 
There is a significant emphasis in the government trying to increase the health outlay but the problems remain in the implementation of schemes primarily due to lack of trained manpower and inability of the society to bear the higher cost associated with better level of training.
 
This quality perception is exaggerated by the fierce competition among private providers, which compels them to satisfy customers by focusing on the immediate relief of symptoms rather than the most effective treatment.
 
The use of public sector, becomes at times, challenging due to huge numbers, time taken in delivery and communication issues. The other extreme of this spectrum who are willing to pay a arm and a leg only to take treatment at the most expensive private hospital, thinking that that the price correlates to quality. People need to informed and educated to take better decisions and having a long term vision on their health condition rather than looking only at the emergent treatment.
 
The government hospitals are now covered under a direct patient feedback system by the name of Mera Haspatal. The patient is directly invited to give a quick feedback and score the services using their registered mobile number. Such systems should be adapted by all hospitals and even shared with policy makers to help better plan healthcare delivery. Further quality certification authorities, in addition to their mandate should reach out to the institutions in facilitating and helping them develop and adapt standard operating procedures and other quality requirements.
 
The feedback also has to matter, because if it is not acted upon, citizens will lose interest. It must be integrated into the human resources management system of the staff, including annual performance reviews, promotions and transfers. But there is no comparable platform in India today that reaches the three-quarters of Indians who live in rural areas.
 
There are other concerns that are being addressed at some level although a lot of potential exists in increasing the participation of private sector in these roles like reducing the cost of consumables and devices – price capping, best practices, and has it really reduced the cost of treatment.  Increasing training facilities under skill India at an affordable cost and increase participation in community health programmers maybe through CSR activities.
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