Demonstrating the benefits for patients and physicians will greatly promote interoperability, hhealth information exchange and digitalization of medical records in Asia Pacific.
Dr. Mahesh Appannan, head of digital health at the Ministry of Health Malaysia, Seyoung Jung, assistant professor and CIO of Seoul National University Bundang Hospital in South Korea, and Gareth Sherlock, CEO of Turimetta Consulting and former CIO at Cleveland Clinic London and Abu Dhabi, delved into best practices and challenges in EMR implementation during the panel session ‘The EMR Experience in Asia-Pacific’ at HIMSS24 APAC.
Thiru Gunasegaran, Editor-in-Chief of HIMSS for APAC, who also served as a panel moderator, shared initial findings from their latest region-wide survey of healthcare providers’ experiences using EMR systems, noting that physicians spend an average of between five and six hours working on spend EMR system.
When asked what a good amount of time should be to spend on EMR, Sherlock promptly replied “as little as possible.” He said the time spent on the EMR is determined by factors such as specialty, payer expectations and regulatory compliance.
For Dr. Appannan, it depends on the type of case. “Complex cases take more time.” He said the time a pharmacist spends following up with doctors about their prescriptions should also be taken into account.
System automation, which is increasingly being adopted in healthcare facilities, can also help save time when completing an EMR, Dr. Appannan added. “Our doctors in electronic clinics in Malaysia can see a patient within 10 minutes because we have innovative ways of creating templates… and that saves a lot of time. We also (use) voice-to-text that (automatically fills in clinical notes) while We speak to the patient.”
In the context of the ongoing During the doctors’ strike in South Korea, Dr. Jung that medical professors now “don’t have enough time” to put complete medical information into a patient’s EHR.
Demonstrate benefits
The panel also discussed challenges and best practices in hospital and health data integration and sharing.
“I could go to a hospital in central London… and go down the road to a private hospital. One has an EHR, while the other is on paper. They have different cultures, staff numbers, workflows, outcomes. .. when that happens within a few miles of each other, it shows the great inequality and enormous challenges we have,” said Sherlock, demonstrating his point that many organizations are still largely paper-based.
“We need to achieve that coordination and standardization and look at data quality (to enable data exchange).”
While agreeing, Dr. Appanan emphasized that organizations should not forget to engage the most crucial actors in health data exchange and interoperability: patients. “Patients (are) the mediators of health information exchange.”
“We need to engage our patients (so they) can take charge and have the information at their fingertips.”
To encourage patients to agree to – and ultimately promote – the exchange of health data, where demonstrating best-case scenarios can be crucial, said Dr. Jung. For example, SNUBH features an AI-powered continuous blood glucose monitoring system Pasta has recently been integrated into the EMR system, conforming to HL7 FHIR standards. “The (mobile) solution helps patients control their own blood sugar levels and also guides their lifestyle changes.”
Drive change management
Another key finding from the study was that clinical decision support systems are the most challenging efficiency tool to implement in hospitals.
Commenting on this, Sherlock said there will need to be a ‘huge cultural shift’ before doctors can use CDSS with confidence. “They need to experience the journey from start to finish and understand how everything will change as they move to this new way of working. Ultimately, it’s their system.”
“The hardest people to change are the doctors themselves… There is always something to refute,” Dr. Appannan added.
Citing a possible use case of CDSS amid the growing global Mpox outbreak, he said: “It will be useful for nurses and rural doctors who are unaware of the latest clinical developments. CDSS (must be) mandatory. Being in Malaysia it is a requirement to have some kind of clinical decision support.”
Dr. Jung highlighted another problem: the lack of analysis of post-CDSS implementation. “Colleagues have complaints about CDSS, but have no ways to report them.”
This then leads to distrust in the use of CDSS, he claimed. SNUBH now wants to be validated for the new AMAM24 model, which also evaluates an organization’s analytical lifecycle, from development and implementation to evaluation.
Joint effort
Dr. Appannan calls the process of implementing and deploying EMR a “science.” “Before we deploy and implement EMR, planning – including having the basic infrastructure and connectivity in place – is critical… You need to have a fantastic pre-deployment strategy.”
The Malaysian government, he said, is now focused on bringing together all stakeholders in the healthcare system collaborate on the development of standards for digital transformation.
In establishing national mandates to leverage EMR and enable health record sharing, Sherlock suggested offering incentives.
Overall, Sherlock suggested thinking about the intended outcomes an organization wanted to achieve from implementing EMR.
“What are the big things you would like to achieve? What are the clinical and business processes that need to change to make that happen? Then explore technologies to enable those business processes to deliver those results.”