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• About 42% physicians use an electronic health record solution to document their patient care and about 1 in 3 uses an EHR during a patient encounter.
• Overall, 62% of physicians and 81% of patients have a positive perception of documenting patient care electronically.
• Forty-five percent of patients had a "very positive" perception of their physician or clinician documenting patient care with a computer or other electronic device.
• More than 60% of physicians feel the best benefit to using EHR is the access they have to patient records in real time.
• Physicians also believe that the ability to seamlessly share information with other doctors, pharmacies and payers are one among the most important benefits.

" In an earlier column, I complained that IT spends a lot of time providing electronic tools for clinicians--electronic health records (EHRs), computerized physician ordering systems (CPOS), etc.--but not enough time developing tools to improve patient education.

I was wrong. Digging deeper into this area has convinced me that there are all sorts of practical technology-based resources to help patients understand their treatment and how to comply with their doctors' advice. Computer-generated questionnaires, medication resolution programs, and sophisticated videos are making a difference in patient care. "

India can be a market leader in this space !

" Four years after a pilot project to computerise services at state-run medical colleges and hospitals was launched, the state Medical Education Department has done a rethink and no longer considers the idea “feasible”.

This is typically what happens when these big buck projects are implemented with a Top-Down approach. A bureaucrat with a lot of money to burn decides this is a clever idea and tries to put it into practise. ( Because there's lots of money involved, it's easy to grease palms) . The results are very predictable - the project flops because there's no buy in from doctors . The project is then scrapped - and the technology gets a bad name ! It's not the technology or the idea which is flawed - it's just the way it was implemented. However, this will set EMR projects back by at least a decade, as everyone will now believe that the failure of this project " proves that EMRs do not work in India "

Patient Centered Health Internet: "Eventually, the IHE-based Health Internet will support patients as equals on the Health Internet. Eventually, the routing between different IHE nodes will be more direct, and then the benefits of IHE might begin to outweigh the benefits of the simple Direct Exchange.But for now, the Direct model empowers the patient in ways the IHE model could never hope to."

New models will allow patients to share their medical records with other doctors - and with other expert patients as well - many of whom can give excellent advice, since they've "been there , done that " !

Why do Indian doctors continue practising in exactly the same way their seniors did 40 years ago ?

A major lacuna is the poor quality of medical records which most doctors keep. The medical record is the heart of clinical care - and yet it's extremely poorly maintained in Indian clinics today. The majority of doctors do not even bother to store and keep their patient's medical records - they just write down their opinion on their letterhead and hand it over to the patient. Usually, this is just a laundry list of tests the patients needs to do and a hand written illegible scrawled prescription - without even a mention made of the clinical findings or what the diagnostic impression is ! While it's good that the patient owns his own records, what happens if the patient forgets to get his records for the next visit ? This creates a lot of frustration for the doctor, who berates the patient for his carelessness - but the damage is done ! Wouldn't it make much more sense to keep a copy - and give one to the patient if he wants it ? Is this a lot of hard work ? Not anymore ! In the old days, one would have to make carbon paper copies or provide xeroxes, but using electronic medical records, this is now very easy to do !

Clinical care protocols are very similar in the US and in India. This is hardly surprising - after all, patients are the same the world over , and most will need the same kind of treatment. However, while most Indian doctors will provide exactly the same standard of medical care a doctor in the US does, why is there such a big difference in the way they keep medical records ?

In the US, every medical encounter is carefully documented ! Perhaps this was originally done for protecting against lawsuits for medical negligence; but today, the US government is making it compulsory for all US doctors to use EMRs - not just to improve the quality of care, but also to reduce costs ! Why don't Indian doctors use exactly the same approach to documenting their clinical care ? Are they too busy to do so ? too lazy ? or do they feel it's not important enough ?

Why do most doctors in India not bother to document their clinical encounters well ? Why is medical record keeping still shoddy and badly done in most practises ?

If Indian doctors understand the clinical importance of keeping good quality medical records, then why are they so reluctant to use EMRs ( electronic medical records ) ? In the past, it was true that PCs were very expensive; and that few doctors would afford them. Also, many older doctors were not very computer -literate; and the software programs which were available for medical record keeping were very doctor-unfriendly ! A combination of computer-unfriendly doctors and doctor-unfriendly software meant that most doctors were quite disillusioned with EMRs and were not willing to use them.

The good news is that things have changed dramatically ! Technology has improved; computers have improved; and Indian medical software companies such as Plus91 ( in which I am an angel investor) are realising the importance of mapping the doctor's clinical processes and respecting his work-flow so they are now making EMRs which are doctor-friendly and which enhance his productivity !

So why aren't Indian doctors rushing out to buy these , given the fact that they are inexpensive and can help them to improve the care they provide to their patients ?

Partly, this is because of the unhappy experiences doctors have had with Indian medical software in the past. It was the computer-savvy early adopters who were the first to lump on the IT bandwagon 10 years ago, to try to use computers to improve clinical care. Unfortunately, they burnt their fingers, which is why they are reluctant to try again.

As a consequence, most doctors do not know any one else who is using EMRs; and because they have little exposure to practise management skills during their training, they still do not understand the value an EMR can provide to their life.

Another major problem is that Indian doctors are not willing to pay for this. This is because they have been completely spoilt by the pharma companies . Because they are so used to getting everything free from pharmas, they are not willing to pay for anything at all ! This means EMR companies find it hard to sell their products - but if they do not generate revenue, how will they be able to produce good software ?

Please remember that your patients form the heart of your practise - and your patient's medical records are worth their weight in gold. If you keep them carefully; update them religiously; and share them with him, you can show your patient that you have all his medical details on your fingertips. This will help to inspire confidence in your clinical skills . Patients will rave about how well-organised you are - and this word of mouth marketing will help you get more patients, as it differentiates you from other doctors.

Also, by keeping your patient's records, you are creating a lot of patient loyalty and "stickiness" . If your patient is confident you know all about him because you have all his medical details, he is going to be very reluctant to switch doctors - after all, who wants all the hassle of explaining his medical history all over again to a new doctor ?

However , if you do not keep your patient's records; and the patient has to start explaining everything which has happened to him every time he sees you, be is likely to lose confidence in you very quickly ! ( That doctor does not even remember my name - forget about my medical problems !)

Hospitals in India have started documenting medical care electronically; and boutique medical clinics and chains have also started doing so. This is very heartening progress - and doctors who do not start doing so soon are going to find they will start losing their patients to computer-savvy doctors ! You need to move with the times - or you will get left behind !

This is a guest post from Mr Aditya Patkar, Marketing Director, Plus91.

Patient Safety is a vital aspect of healthcare. Medical errors can lead to deaths and medical tragedies which are preventable , leading to heartburn and losses for all doctors and patients . In any industry, software is used to improve efficiency and accuracy. I am going to highlight some basic examples as to how medical software ( electronic medical records, EMR and practice management software, PMS) can be used to improve patient safety.

1. Prescriptions and Medications: The commonest errors occur when doctors write prescriptions on paper and the patient or the chemist misreads the prescription. This is a common occurrence and a printed prescription generated from software with prepopulated Drug Data is the safest bet against such a mishap. Other errors which can be prevented include: mistakes made by doctors in writing the dosage or strength( which intelligent software can automatically prevent) ; and the inadvertent prescription of a combination of drugs which can cause harmful drug interactions. These features are already present in the Plus91 clinic package , Clinkare. This ensures standardized prescriptions, reducing the possibility of error and confusion !
Another neat feature is sending reminders to the patient to take their medication at the correct time via SMS. This ensures high patient compliance , because missed dosages could lead to major problems in treatment. This feature is available in ClinION , the hospital management solution from Plus91 Technologies.

2. Patient History: If doctors are in a hurry, and if a patient comes without his old case papers , the doctor may end up prescribing the wrong treatment ! Not having easy access to the past medical records is a major pain point for all doctors ! EMRs allow storage and instant retrieval of the patient’s medical records, allowing doctors to make better medical decisions , thus ensuring patient safety. This feature ensures that the doctor no longer needs to rely on his error-prone human memory ! Intelligent EMRs also have built-in Clinical Decision Support systems , to help the doctor practice evidence-based medicine.


3. Patient Data Entry: As we know, GIGO holds true – garbage in, garbage out ! Accurate entry of patient data in the system can be ensured by various validation measures and checks in the software. A simple example is the use of validated fields , which accept only values within a pre-defined range. Thus, if the value for hemoglobin is entered as 100, this will be automatically rejected !

4. Check for Informed Consent: A patient must know what procedure they are undergoing – what the risks are; and the important dos and don’ts, to help ensure a good outcome . A software program can ensure that the consent forms are filled in using a reminder / validation system , to ensure that all the patients queries have been answered. It’s also possible to use a video/presentation format , with a consent thumbprint or electronic signature taken at the end. This is helpful for risk management, because it documents that informed consent was obtained. It also ensures that the patient follows all the key preoperative instructions ( such as coming on an empty stomach before surgery . )

5. Check lists: A checklist ( as described in Dr. Gawande’s new book “The Checklist Manifesto”) is the doctor’s most trusted friend. Clinic software programs come with check lists which need to be marked as complete before the next set of tasks ( on the next screen) can be accessed. This ensures that all important steps are carried out in order.


6. Alerts and reminders. SMS or Email alerts can be automatically sent by the software, when there is a problem. For example, if a key lab value falls out of a particular range , the doctor can be automatically alerted, so he can take the needed corrective action !

This is a guest post from Mr Aditya Patkar, Sales Director, Plus91, in which I am an angel investor.

As we improve our software products and work with more doctors, we are learning a lot about what doctors in India want from information technology . How do Indian Doctors view IT as an enabler ?

In theory, one would expect doctors to want to use IT for the following applications.
1. Computer Based Medical Records (EMR)
2. Clinical Information Sharing Networks
3. Clinical Decision Support
4. Administrative Functions – Accounts and Patient Profile Management
5. Computer Generated Prescriptions
6. Better Patient Communication and Care

However, what the practicing doctor wants in real life is quite different !

So what does the typical doctor’s list look like?

1. Accounts and (Mis)-Management

Indian Doctors give a lot of importance to accounting in their Clinic Software; they expect the package to bill as per their requirement. Unfortunately, because many of them do not always want to declare all their income , they want the software to provide “deductions” . We have to educate them that a good package will help them to improve their cash flow and collections by allowing them to track their patient inflow so that they know what business they are generating on a regular basis. Intelligent software will help to prevent embezzlement and will discourage the office staff from pocketing the doctor’s hard earned money ( which is easy to do , since this is still a predominantly a cash business today)

2. Referrals Management

Referring patients to specialists and other clinicians is a common practice the world over, but in India it has an additional financial angle. Doctors want to know how many patients they were referred and by whom, so that they can make the necessary payments back to the referring doctors.

3. Medical History

Doctors want easy access to their patient’s information to help them make better medical decisions. While they are happy about the fact that the software gives them instant access to the patient’s medical records, they are still reluctant to use clinical decision support tools, as they would rather depend upon their clinical ability, than use a computer .

4. MIS ( Management Information System( Reports and Patient Registers)

MIS reports and registers are a commonly requested feature . Sadly the uninitiated ones forget that data first needs to be entered properly , so that it can be intelligently extracted. The reasons for the MIS reports are both noble (research purposes) and mundane (for filing income tax returns) .The biggest challenge here is designing forms and data capture mechanisms which give useful reports. Often , there is a big disconnect, when doctors design incomplete templates , and still expect to be able to generate relevant data ! . Garbage In = Garbage Out !

5. Custom Designed Templates

Plus91’s software has designed so that doctors can customize their own templates , to suit their personal preferences.. Doctors love this feature, as each one wants to design something as per their own workflow.

What of the future ? We hope that as the Indian doctor matures and becomes more comfortable with using IT, he will want the following features as well.
a. Clinical Decision Support
b. Computerized Prescriptions
c. SMS/Email alerts and reminders
d. Online EMRs
e. Insurance Claims Management

Plus91 software is already built to provide these enhancements, which will give a definite boost to the quality and efficiency of their practice , and also help them to improve their profitability.