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EMR: a doctor-patient perspective

Electronic Medical Records (EMR) are digitalised clinical notes, which contain information such as patients’ general information, history, investigation results, diagnoses and treatment plans among others. It is all the rage in the healthcare industry, and Malaysia is adamant not to be left behind, especially by its South-East Asian counterparts. Currently, 25% of hospitals in Malaysia are equipped with Hospital Information System (HIS), while 7% of government clinics are equipped with Clinical Information System (CIS). The Health Minister, Dr Dzulkefly Ahmad had announced in July that RM1.5 billion is expected to be incurred as the ministry rolls out EMR system to all 145 hospitals within the next five years.

Many articles on the matter published by local newspapers and widely available for the general public often highlight the benefits of the system’s implementation. I get it. Having digital infrastructure in Malaysian hospitals may actually help achieve some of the ministry’s strategic objectives and facilitate comprehensive and integrated care for patients. However, I feel that one shouldn’t ignore the struggles that come with it too. Also, note that the system is not self-operating. There are clinicians who key in all those information into the system, there are patients’ who are affected by the usage of the system, and there are healthcare administrators that have to manage the system and its output. And yet their unique views (both positive and negative) are not out there.

I have been on all three sides of this story. I have been a clinical doctor in a hospital using EMR, a patient in hospitals with EMR, as well as a healthcare administrator in a hospital with EMR. And I intend to put my positive and negative views from all three angles right here in this article. I know it won’t change much in the grand scheme of things, but I think it’s only fair to share this with you (my readers). Take this as an act of balancing the scale if you may. I hope this article finds you nodding in agreement as it resonates with your experience as clinicians, patients, or healthcare administrators. Or maybe finds you shaking your head in disagreement too, and perhaps we can agree to disagree.

Pros as a patient

Well, for starters you (patient) don’t really have to rely much on your memory trying to recall your previous progress or blood results for example, because your doctors could just review those information and results just by clicking a few buttons on the EMR system. For someone who is being seen by as many as six (6) specialities at a time, I definitely would appreciate having such system in place (a hospital that I frequent as a patient does not have EMR). Not to mention that the system may allow detection of an alarming pattern of results which may protect us as patients. Also, not having to carry around prescription slips once your doctor is done with you because the pharmacists can view it on the system is just fantastic – one less document to deal with.

Cons as a patient

It is not as fantastic though when your doctors fail to maintain eye-contact and have meaningful discussions with you because they are too busy typing away information into the system. Who can blame them? The system that aims to facilitate care has ironically taken out ‘care’ from the equation. There’s also the cybersecurity risk that your health information may leak, breaching the security and privacy of your personal data. It has happened before, and it can happen again. Plus, there are many human errors that can be magnified by ‘weaknesses’ inherent to the system. Clicking errors in prescribing are particularly rampant in hospitals with EMR as doctors become accustomed to the rapidity provided by the system, raising the level of patient safety hazard more than ever before.

Pros as a doctor

It’s amazing what EMR would allow us (doctors) do. We can trace patients’ old clinical notes faster, check out what our colleagues from other disciplines are/ were doing for the patients, review all investigation results, refer our patients – all in just a few clicks away. Contrast these with days of waiting for patients’ old clinical notes, lack of communication across multidisciplinary teams, delay in receiving investigation results and the need to produce actual hardcopy referral letters. Needless to say that the rate of which patients’ healthcare information becomes available through the system also assists doctors in making diagnosis and treatment/care decisions. Ultimately the ease that comes with the system translates into better care integration for our patients and better outcomes.

Cons as a doctor

Copying and pasting old entries to ‘summarise’ patients’ progress has become quite a phenomenon as the system lend itself as an efficiency tool in the industry. It diminishes doctors’ summarising skills, which is crucial for inpatient care. It may even result in patient harm if care is not taken to ensure that doctors are not copying outdated diagnosis from which patients have recovered from which can result in the continuation of unnecessary treatment that can be harmful. The system which often has many mandatory fields to be filled also make us doctors feel like we have somehow turned into data-entry clerks as opposed to being healthcare professionals that provide patient-centred care. It may lead to burnout as it shifts our focus from caring for our patients.

Pros as a healthcare administrator

It is the best thing since sliced bread. Well, at least in healthcare administrators eyes, which explains why all press statements about the EMR system thus far has been harping on its benefits and nothing else. Healthcare administrators just love it. It allows us to monitor the efficiency of processes, the achievement of targets, financials, and even patients’ movement within the walls of the hospitals. I can literally just ask for a data set to be formulated by hospitals’ IT officers for almost anything I wanted to analyse further and it has helped me and countless other colleagues in our pursuit of improving the hospital services. And the fact that the system reduces our paper wastage and need for physical storage space made it all the more attractive to us. Helping both patients and the environment, no?

Cons as a healthcare administrator

Well, until we realise how much space server room takes and that in producing energy to maintain servers for the system many trees may have been harmed too. So much for saving the environment by going paperless. Not to mention that maintaining the servers cost more than buying papers and its storage facility. Operating and maintaining a system as complex as EMR is time-consuming and requires technical expertise and infrastructural updates which raises its need for massive capital investment on a regular basis. Can we afford this? Are we really using it to help us achieve our strategic objectives? What decisions are we making with the data and statistics that are made available to us by the system? Or are we losing sight of what is important by jumping on this EMR bandwagon?

I know it seems unfair for me to pose those final questions. They are not really “Cons as a healthcare administrator”, so to speak. But they are there because I have no answers to them, and in not having answers they (well, at least to me) could potentially become lurking negatives that could render the EMR system pointlessly expensive. Maybe a thorough cost-benefit analysis has been done by the ministry and the result is promising, hence the press statements of the plan to roll it out to all hospitals in half a decade. I wouldn’t know the details of that. But as I’ve said earlier, everything I’ve written in this article is just my effort to offset the mostly positive information published about EMR out there. Counterbalancing perspectives from a doctor-patient-healthcare administrator.

It has been great writing this article. Below I provide a list of some related press-releases, articles, blog posts that I’ve come across while I was doing my reading around the topic. If you have other articles on the topic that you would like to share with me, please link it in the comment section below. The list that I provide is not exhaustive and I am by no means an expert on the topic, which is why your input is valuable and greatly appreciated. Please feel free to engage in discussions on the matter or challenge my views. I’d like to know that it isn’t just me who is feeling slightly unsettled with what seems to be a one-sided view of the EMR rolling out plan. I believe that it is not all good, but at the same time, it is not all bad either. Thank you for reading.

Related articles

  1. All hospitals, clinics to have EMR system in 3 years, says minister (NST, March 26, 2019)
  2. The Electronic Medical Record System for Malaysian Healthcare (SysArmy, April 26, 2019)
  3. Electronic medical record system for all M’sian hospitals, clinics to cost up to RM1.5b, says minister (The Edge, July 2, 2019)
  4. Malaysian MoH developing electronic medical record system (Opengov, September 23, 2019)
  5. Malaysia Patient Data Leak Came From Private Entity, MOH Says (CodeBlue, October 10, 2019)
  6. Malaysia To Launch Electronic Medical Records By Mid-2020 (CodeBlue, Oct 16, 2019)
  7. The healing patient-physician analog relationship is in critical condition (KevinMD.com, November 7, 2019)
  8. Yale study links electronic health record systems to physician burnout, medical errors (Hartford Courant, November 14, 2019)

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