By Dr. Sreenivasan Narayana
The response to the pandemic has required real-time and continuous innovation that ensures quality care. In the last 15 months, while treating the rising tide of patients with COVID-19, many doctors found themselves working in an unfamiliar setting, treating an unknown disease. With little known about the coronavirus and evidence changing daily, there was an inadequate authoritative information to support clinical decisions. This posed a challenge for the doctors, which was to match symptoms with treatment recommendations and increased the need of having updated and reliable information at the point of care. And this is how, during the uncertain times of the pandemic, the role of digital technologies came to fore. From artificial intelligence assisted healthcare services like predictive healthcare diagnosis and automated analysis of medical tests to mobile applications such as Aarogya Setu booking vaccine slots, digital technologies are revolutionizing medical treatment processes in India at an unprecedented rate.
Rising to the challenge of providing precise information to the doctors at the time of treatment, we also have Electronic Medical Records (EMR) that with the help of advanced technologies, capture, store, distribute and analyse huge amounts of health data. To define EMR, it is the digitised version of paper records at a medical facility that entail information such as treatment history of the patients, laboratory results, details of immunisation, among others. As we move towards a paper-less and digitised India, to streamline workflows and provide healthcare professionals with the best evidence, advanced digital platforms such as clinical decision support (CDS) systems are often integrated into EMR.
Digital technologies such as CDS encompass several activities. For instance, while carrying a clinical test in a laboratory, if the value of the test exceeds or is less than the normal one, CDS system can send clinical value alerts to the doctor. Based on the alert, the doctor can suggest the appropriate plan of action.
Reducing Clinical Errors and Unnecessary Testing
Moreover, digital technologies are improving patient outcomes by eliminating clinical errors at point of care. The potential reason behind this could be the seriousness and complication of certain diseases, administration of wrong dose and therapeutic route and when the patient does not follow the prescribed treatment. CDS systems along with EMR address such issues as they provide information regarding the harm associated with a particular medication and medical history of the patient, reducing clinical errors.
Let us understand this with an example. A patient with deafness in one ear, visited an ENT surgeon. Certain drugs, if used without proper medical history, can affect the nerves of the other ear of the patient. Therefore, the surgeon after the treatment, provided the treatment summary on a sheet of paper with the name of drugs that should be administered with care or should be avoided completely. Now, if the patient loses or misplaces the prescription, especially at the time of emergencies, these paper records might not be helpful. That is when EMR and CDS systems come to the rescue.
Clinical decision making is a tedious task that entails remembering huge amounts of medical data of several disease profiles. Even though doctors know the treatment route, they may get confused at the time of prescribing medication. Therefore, providing them with the right tools, information, and resources is imperative as it will help them in making informed decisions. A well-maintained database is important, which will include a formal comparison of medicines before and after care. Digital technologies are crucial especially when we are battling COVID-19 and continuous mapping is the need of the hour. CDS systems have updated information about any new drugs that comes in the market which assists in the clinical assessment. For instance, at Narayana Health, we have been using UpToDate for past several months and it has been a great support system for our clinicians, residents and nurses in providing evidence based medicine and treatment, As different patients have different needs, the platform also provides information if the drug is suitable for a person with certain comorbidities or other medical history. This data on CDS systems are updated regularly by experts who have years of experience.
Rethinking Digital Technologies for Post COVID Times
As the pandemic has highlighted the importance of electronic records in treating the deadly virus, it has also unveiled its potential for predicting future outbreaks of both, the virus and others that may follow.
Today, in line with government’s goals of healthcare for all, India is expanding its digital outreach. As per a report 15-country Future Health Index (FHI) 2019 by Royal Phillips, India is leading in the adoption of digital health technology with 76 percent of healthcare professionals in the country already using digital health records in their practice.
Albeit all efforts, the major hindrance in the adoption of cutting-edge technologies is lack of awareness. Therefore, there is a dire need for accreditation bodies such as National Accreditation Board for Hospitals and Healthcare Providers (NABH) and doctors to advocate CDS systems and other digital tools as well.
Dr. Sreenivasan Narayana, Group Vice President – Electronic Medical Records Implementation at Narayana Health
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