Digital health information promises great improvements in patient care. Healthcare depends greatly on reliable information transmission, so empowering providers to use the products of the information age – computers, networks and mobile devices –promises great productivity and efficacy gains. However, in developed countries, it has so far had little demonstrable benefit because the paper-based systems they are replacing happen to perform their tasks, albeit at a high cost, rather well. Even in rich countries like the US, studies of the few hospitals that have transitioned to electronic health records (EHRs) have showed no significant improvement in their ability to meet best-practice standards and to reduce length of stay. However, many initiatives are underway to digitize health information in the developed world, The Obama administration in the US, for example, will soon be spending more than US $ 100 billion towards developing and incentivizing the use of EHRs. The thought is that, like other networked scenarios such as the Internet, the value of EHRs will grow substantially as more and more institutions digitize their information.
In the developing world, the story is markedly different. Faced with the task of improving health information here for our poor citizens, developing countries are choosing to leap over the stage of developing costly robust paper-based systems in favor of EHRs. India, with a robust IT industry but poor health information, is ideally placed to make that jump.
We are proposing to go further. We will create a health information system that will perform the logistics of patient tracking, store patient information as well as enhance delivery in the field where there is low connectivity and electricity supply. We propose to improve the quality of care by providing up-to-date relevant information as well as colleague consultations to clinicians performing diagnosis and treatment.
1. When doctors know the history of a patient with a chronic disease, they can search into the patient’s past and see what medications or surgical procedures have been tried with success or failure. With an EHR, doctors will be able to see what medications a patient has received, or what symptoms and diseases the patient has contracted, and how their pathologies and vital signs have evolved over time. Comparisons can be made to the standard of treatment for the given condition. In sum, an EHR replicates the paper chart, by containing both clinical information such as diagnoses, allergies, drug resistance and treatments, as well as and demographic information about a patient; it provides both the most succinct, efficient and comprehensive medical picture for determining appropriate treatment for patients. With records that are up-to-date and accessible, the physician’s decision-making process can greatly improve the outcome of patient care.
Clinicians can look up not only medical data, but also whether the patient is receiving non-clinical support, including nutritional supplements or home visits. This ability to track all aspects of patient care provides clinicians with a fuller picture of a patient's health status.
2. Manage Inventory: An EHR will provide an exact data set representing the quantity of each medication and other supplies prescribed day-by-day, at what locations, at what time each day. Stocks can be replenished more accurately and in a more timely fashion. An EHR can enable JSS staff to keep track of drug and hospital supplies. This can reduce, if not altogether eradicate, the number of times a pharmacy is out of stock of a particular medicine.
3. Public Health: The EHR will allow clinicians and researchers to analyze data and long-term trends, enabling staff to produce analysis for public health use, academic use, as well as for internal and external reporting. An EHR will assist public health officials in better coordinating responses to epidemics, better target the most vulnerable populations by time, geography and other parameters. With a few keystrokes the database component of JSS’s EHR will provide a map of its catchment area according to the geo-density of diseases.
4. Oversight: An EHR will provide a level of transparency, accountability and oversight for the care our patients receive. Currently doctors may prescribe dosages of medications that are customary but not optimal. An EHR will manage the dosages of medications our clinicians prescribe, and in some cases provide automatic feedback to our doctors.
5. Follow-up: An EHR allows clinic staff to track patients needing follow-up care. Follow-up is a major obstacle to care in many long-term treatment programs. Tracking patients using an EHR can help identify patients having life-threatening chronic illness that require adherence to a strict drug regimen. When and where our patients have cell phone (or access to cell phones belonging to friends or family) a follow-up SMS can ask if the patient has taken the full course of medication and if so, whether the patient's condition has improved. Drug efficacy and compliance are but just two examples, and may evolve later into others.
Stage 1: At the first stage the patients are registered, identified as new or returning patients, and directed to a specific physician in the outpatient facility.
Step 2: At the second stage the patients are seen by a physician. The physician locates the patient record in a queue, reviews the forms completed by the screener (patient demographics, vital signs and history) and reads over the patient history. The physician then completes a progress note, inputting symptoms and observations. The physician may prescribe an additional laboratory or radiologic test for the patient that goes automatically to the appropriate site within JSS’ environs. At that site, the lab or radiology technician conducts the relevant test on that patient and enters the results in the patient’s record, which is immediately available for review on the physician’s device. The patient can then return to the physician for a diagnosis and treatment plan, if and when appropriate.
Step 3: At the final stage of the process, the patient confirms her medication order, pays for the medication and picks up the medication. This is a three-stage process that ensures accountability and the prevention of fraud. At the first stage the patient steps up to one counter to review their medication order and establish a bill. In the second stage the patient pays for their medications. In the third and final stage the patient picks up their medications.
At the same time the pharmacist receives prescription orders in the sequence by which they were dispensed by the doctors. At the final stage the pharmacist fills the prescription and hands instructions for taking the medication to the patient.
Poor internet connectivity; power outages.
To make this as extensible as possible.
There are a number of implementations of open source medical recrod systems, none of which have tried to be as ambitious and inclusive as the project we propose.
Yes, at JSS (www.jssbilaspur.org), the doctors, nurses, staff are all on board with ths project and look forward to seeing its implementation in the near future.