Hello friends, the glory of medicine is that it is constantly moving forward and in this forward journey Technology has not only helped in procedural or pharmacological advances, but also in advancing the organization of medical information, not only for the doctors, but most importantly for our patients. So, I am talking about this little technological issue because I have spent innumerable hours in our auditorium to know and to have what we want in our hospital's EMR, that is Electronic Medical Record. So, I am going to take you through this technological topic under the headings of what is EMR and why do we need it, what are the commonly available EMRs in the country and how do you choose one which is best for you and what is our experience at Chela Ram Diabetes Hospital with our own EMR.
So, before we go through, I would like to take your opinion. I would categorize the doctors which are working in India as one which is which are using EMR and defined it better than the paper records. Those who are using EMR but think that the past medical records were better.
Those who are not using EMR but are thinking of starting to use it. And those who do not use EMR and say no, I never would want to start with it. So, want yourself to be categorized amongst one of them and let us see if I am able to change your opinion.
So, to start with what is EMR? It's a simple software which you can download on your own desktop or laptop which will help you to digitalize and organize the hospital's operation including registrations. So it can store your patient's history, examination, past available data, allergy to you and it can give you a different makeover to your OPD or your clinic. A different complete professional makeover. It will organize the way your patient look at your hospital and the way the patient is handled in your hospital from the billing.
to the pre-consultation area to the consultation area then investigations and the pharmacy in a bigger setup the emr can also collaborate laboratory and radiological data it's very good for audit and research because we can have in a click how all statistics about your medical records billing records laboratory records and so on and the most last thing but not the least thing is important is it protects your patient's privacy it's a username and password protected record which nobody can hack for that matter. Now when it comes to chronic disease like diabetes EMR even plays a better role because I would agree with you if you would like to argue that a patient who's coming up with fever may not be where it may not be very important to know what was his past medical record about his medications and all but when a person with diabetes comes to you It is very important to know what the patient was taking earlier, what were the earlier blood sugar levels, what was the previous HbA1c and if you have that record, I am sure you all will be handling patients who keep on losing their old records. In addition, diabetes is a multi-speciality disease. A lot of other specialities are required to be considered into taking care of a diabetic patient like cardiology, nephrology.
a cardiologist is giving to my patient and a nephrologist would like to know what are the blood sugar levels what aren't your diabetic medication the patient is taking if the creatinine is rising up so the past medical records and multi-speciality care are two important things which make emr more important in chronic diseases like diabetes not only our own experience but it is proved by the evidence-based medicine that the patient care with diabetes is much better when you are using an emr versus when you are losing A paper based record. Government of India is slowly recognizing the use and importance of EMR in the country. Though it is still in infancy, there was no guidelines earlier, but now government of India is understanding that electronic medical record is the future of medicine and they are looking into the guidelines for doctors who are using EMR. After knowing why do we need EMR and how, let us see what we are going to look at what different EMRs are available in the country for us and how do you choose one which is best for you.
So, in general there are some types of setups under which doctors in India work. One is a single doctor working in his own cabin. He may have a receptionist with him. He or she may have a laboratory attached to his hospital, a pharmacy attached to his hospital. There will be multiple doctors which are working in a standalone hospital or a single doctor like a private practitioner can work in multiple hospitals or a bigger set up hospital can have multiple satellite clinics at different places.
So, let us see what are the different types of EMRs which will help us in getting usefulness in different different different setups. So, there are three types of EMRs available. One, is windows based, another is web based and third is app based.
So, the windows based EMR are useful for single doctor or a standalone hospitals because they can be connected with the different laptops or desktops can be connected on windows based softwares with an intranet, but they cannot be taken out of a building. The advantage of windows based EMRs are that they are very good for privacy and protection of your data. Vis-a-vis of web-based EMR is good if you are moving around. If you are not situated in one building and want to move around, web-based EMRs are good because as long as there is an internet service available, you can use such a software at any computer, at any place, anytime, anywhere.
Now, the third is one step ahead that is app-based EMRs. These EMRs are equipped with an app which can be downloaded on the mobile where the dock. can enter the data on his or her own desktop and the patient can get the information on the app and the doctor can get connected to the patient remotely through the app.
So, what do we expect from an EMR? Whether it is windows based or whether it is web based EMR, the EMR can do everything for you from the billing and it can send the data to your desktop by having an organized flow of the patient. It definitely is the most important reason why we have EMR is medical record entry and the patient past management records and you can connect to a pharmacy as well as laboratory to the EMR. So as soon as we are at the billing counter the patient can get registered in the EMR it can he can take appointment receive an SMS that the appointment is confirmed and a front desk is it's very easy for the front desk to manage the appointments.
After the patient gets the billing we can have a pre-consultation area where your paramedic or nurse can record the vital parameters, height, weight, blood pressure and you immediately get the entry in your cabin even before the patient is entering your cabin. Now, electronic medical record entries are not as difficult and as time consuming as they were thought once to be. There are certain sets of questions I am sure you all agree that we ask to each and each one of our patient.
Especially in diabetes, I have few questions like since when you have diabetes, is there any family history, is there any past history. So, these can be recorded into medical record entry through a template. So, the template is ready and you can just tick on what is the answer of the patient while you are talking to the patient.
So, medical record entry is nowadays very easy. Again, when it comes to ordering the investigations. We have a certain set of investigations like annual checkups.
We know that these are the investigations which every patient will need to be reviewed with at a certain point of time. So, if I have it ready as a set of questions, with one click I can order 10 number of questions which I have to, we can avoid writing down for each and every patient. Reviewing of the report, if I have a lab in my clinic and it is connected to the EMR, even before patient is in my cabin, I can have a look at the reports.
And the patient saves time by not going to the laboratory and getting the reports and then coming to you. The next important thing is that we can review the patient's old record. It's not only important for us to review the old records.
If an example of a patient comes to me and I can show her what is her HbA1c trend for last one year, I can tell her that this was the time when your HbA1c was high. What was something and then we change your treatment and then your HbA1c came down. and now something is going wrong and your HbA1c is again going up. So this can definitely motivate or encourage her to go back to the things she was doing when her blood sugars were absolutely controlled.
So this is the beauty of EMR which can give us information and give information to the patient which can motivate them. When it comes to the prescription, the most important part of our patient care, the EMRs are nowadays equipped with learning algorithm. That means that if I have to order a certain invest in a medication to a patient, once I order let us say for an example I want to order metformin. So, when I write metformin and first time I write to the computer that the metformin is given twice a day in certain dose after the food at this particular time and certain instructions for which I would like to give for metformin like it may cause gastric irritation.
So, my computer would learn automatically that this is what is about metformin. So, as soon as I write M E T, the computer can suggest metformin and can also suggest all everything else that I have to talk about the metformin. So, it comes automatically and I may not accept what computer is suggesting it. If I want to edit, I can always do that.
It also makes sure that I am writing all the instructions required for giving that particular tablet. I don't miss that the medication has to be taken before or after food. I don't miss any particular information about the side effects of the medicine.
So it takes care that we are giving all the information. There are EMRs nowadays which are equipped with prescription in the regional language. So you don't have to worry that my patient doesn't understand English.
How will he read my printed prescriptions? And I'm sure you all would agree that a beautifully printed prescription is very much more appreciated compared to the defamed. a handwritten prescription of a doctor. So that's where EMR also is very important. Now if you have a pharmacy and it is connected to your EMR, what you can do is that as soon as you finalize a patient's prescription, the prescription can directly go to the pharmacy and a pharmacist can keep all the medications ready even before the patient reaches your pharmacy.
Audit and research is one of the most important aspects of using the EMR. Not only medical audits but also billing audits, laboratory audits, how many patients I have seen, what was the good period for my OPD, what was the lack period of my OPD. All this can be seen just at a click moment. Then when it comes to medical audit, even if I do not want to publish or research, do a proper research, if I just want to see that there has been a new drug in the market for last 3 months and I have been using it, I am interested in knowing what this drug is doing to my patient, whether it is working for my patient, how many of them are achieving HbA1c with this new drug, I can do with the moment in a moment with the EMR scale.
Now going one step ahead, if you want to involve your patients in the patient care, then there are certain sort of sorts of EMR which are also equipped with an app which can be downloaded on your patient's mobile. Now, what we can do is that whatever data I am entering for this patient on my desktop, the patient can retrieve it on his mobile through the app and the doctor can also get remotely connected, the patient can send the blood sugar levels and if the insulin doses are to be adjusted, the doctor can send the revised insulin orders. This really helps in retention of the patient to you because the patient feels connected with you. Now, such... EMRs can also be equipped with an intermediate coach which can fill in the gap for you if there is a minor advice related to diet and exercise to be given for the patient.
So, that is one more additional advantage of having app based EMRs. I try to do a little homework about knowing what are the good EMRs in the country available and I found that there are many good ones. multiple EMRs available in the country. Some will have some advantages, some will have some disadvantages.
For example, some might have option of giving a prescription in the regional language, some might have an option of getting your information recorded when you are offline when there is no internet, some will have diabetes intermediate coaches, some will have visibility through internet and some might have certain advanced app which you would like to increase your professional look to your clinic. So there are list of EMRs which are available and you can go through them and choose one which is best for you. After having talked about what are the different EMRs available, I would like to take you through a live tour of what we are experiencing at Chalaram Diabetes Institute with our EMR.
So there is a small video over here which I would like to take you through and it's a video of our EMR getting used. So the beauty of EMR starts with that it is password protected. So no one can mess with the records of my own patient and it's only me who can go through them and use them and I'm sure that nobody can misuse.
So, as soon as I open my desktop, I get a list of people who are pending for my today's registration. Then, when I open the concerned patient's record, I can decide whether I want to make the presentation final. I would have a pre-consultation area where the nurses are entering the records which I directly get on my computer.
When it comes to adding the history or entering the history and examination, we have a pre-filled pro forma where I just have to click on the things which are positive and negative and if I want I can write or type few words over there. So, it becomes very easy and as you get used to it, it hardly takes any time, definitely lesser than what we are taking to write all that down on a paper. and in a better manner.
Now, this is how a prescription looks like. As simple keywords put on the put in the box will give me suggestions. Then I can write and I can be sure that I am not missing any information to be given to the patient about a particular drug. There are options of whether I want to give the medicine for once a day, twice a day, thrice a day or n number.
This is something which you can edit according to your own needs, the way you practice. the way you want to write, the way you want to convey the patients. So, this is all editable, this is what we have edited for our own comfort.
So, and you can use it the way you want it plus I can give some instructions in addition to what I would generally give for each and everything. Now, when this move on to the past medical record, If I have a list of medications this person was on in the past, I can just click on the medicine and the whole thing, the list can come and I save all the time to type or write all the medications. I can write some notes in the discussion of a particular patient if it is not the typical one.
I can ask the patient or the computer to calculate the date of follow up if I want the person to come after a particular days. I can enter ICD related diagnosis and I can always look at the data which. this person is taking in the past.
So, the past investigations or the past consultations this patient has referred to all can come in. This is a beautiful example of what we can do with the EMR when it comes to past record of the patient. For example, if I wish to show my patient what has been the improvement or decrement in the HbA1c level, I get a beautiful graph of her HbA1c levels in the past and you can show that to the patient.
So when I am done with the patient and if I click on the output, what I get is a beautiful summary of what I have entered for this patient. I may decide that I want to give the whole summary to this patient if the patient is coming to me for the first time, including the patient's history, previous examinations, previous medications and current medications, what I feel about this patient, a small discussion. Or I may just decide to give her the particular consultation notes which I wish, the one in this consultation form or I can just decide I want to give this patient just a prescription and nothing else if the patient is coming to me again and again, I do not need have to print all the information every time.
So in the subsequent visit I can just decide that I want to give only prescription to the patient and again. to stress that all this is possible to be edited the way you want it to be. So, this was what we are doing in the OPD. Now, when it comes to our EMR in the IPD which has been a difficult task to do and I am sure it is EMRs in the IPD are still growing, they are still in infancy, but we have started using laptops and tablets on the round. So, we are not taking any papers, the doctors enter their notes on the laptop and the nurses at also enter their whole information on the laptop.
We are trying to be paperless even in our IPD. So, we are entering the admission notes, entering all the daily progress notes, nursing vitals and at the time of discharge summary, we just have to click on the things which we want to pull in the discharge summary and our discharge summary is ready which looks like this. We give all the information including the patient's history, what were previous medications, what did we do during the course of the hospital.
what are the medications at the discharge and whom to contact and all the advice I want to give. Even nurses are entering all the data into the system and we are not using any trying to use any papers in the hospital. When it comes to a particular management of diabetes in the hospital the EMR can help in a lot of way. We in our hospital we are using a uniform protocol based management of hyperglycemia in the IPD.
So, there are particular drip rates or when it is in the ICU when we are using IV insulin we have pre-calculated drip rates and we are trying to inculcate this calculator in the EMR so that the EMR can suggest us what drip rate should go on and how are the changes or how are the modifications in the drip rate we need to do. Again when we shift the patient to the subcutaneous insulin the protocols can help us in calculating the correction dose if the calculators are fed in the system. So this is how we are doing. we are using our EMR in the APD for protocol management of diabetes as well as getting beautiful output in form of a discharge summary. So to summarize my talk, EMR is a good tool to improve patient care and establish an impressive diabetes practice.
But definitely you need to choose an EMR which is best suited for your practice, your clinic or your hospital. If you are running a multi-speciality hospital for diabetic patients, I would say EMR is a must. And we all have learned it so many times that it all, it can save all your time, space, papers, it can reduce errors and The era of involving patients into diabetes care management is nowhere far. Thank you so much.