The healthcare sector is at the forefront of the battle against the pandemic and bears the most predominant and essential responsibility. The sector has leveraged technology to great effect and stepped up its role. It has succeeded in its mandate and saved millions of lives across the world. Although the healthcare sector was previously a late starter as far as technology adoption is concerned, it has ramped up its efforts over the past several months and underwent tremendous transformation.
Rajiv Gandhi Cancer Institute & Research Centre (RGCIRC) is one of the foremost healthcare providers of the country and has taken up technology adoption in a big way. It has implemented the Electronic Health Record (EHR) system to great benefits and integrated it as well with the Hospital Information System (HIS) in a holistic fashion. The IT landscape has been simplified due to the integration of the HIS and HER, which were previously separate systems. They have been integrated through an Integration Engine (Mirth). Now, everything is contained in a single database.
According to JP Dwivedi, CIO, RGCIRC, the institute had been trying to implement the EHR system for the past several years but with limited success. The doctors used to avoid using the EHR as they used to find it easier to write on paper than answering multiple choice questions or typing the diagnosis, prescriptions and tests (while the patient was sitting in front of the doctor).
However, they did want the EHR for easy access of clinical records with charts and trends of lab results, etc. Another reason for the demand of electronic record was facilitating research work and publishing papers.
“Thus, we needed a system that did not affect clinical productivity, did not ask too many questions and did not require much typing. Even the doctors who adopted EHR expecting data retrieval were disappointed because they needed to traverse through several screens to get what they wanted,” says the tech leader. At RGCIRC, every specialty has a different workflow and different data requirements. Their set of tests, procedures and medicines are also almost fixed with little variations. Dwivedi understood this and put it to good use.
“We had been trying to fit a generic EHR into a Cancer Care Institute and had been failing. I have been observing that in our Institute, specific units specialize in Cancer of specific organs. This gave me an idea that if I deliver a system that studies and learns most frequently prescribed tests, procedures and medicines and then pre-populates them with average adult dosage and frequency, it would take less than half the time that doctors usually take in writing prescriptions,” points out Dwivedi.
He also observed that doctors wanted to prescribe doses of injectible medicine without worrying about standard packaging (250 mg, 500 mg, 1 gm, etc.) and that there is a formula to calculate a dose based on Body Surface Area. Thus, an option to automatically calculate dose was devised based on height and weight. The team created a clinician friendly drug database (different from pharmacy drug list used for recording sale or inventory management).
They also worked upon compiling the reports for easy viewing of past data (for example, all clinical notes recorded during OPD visits stored as independent elements and marking them as critical or non-critical) and helped create a single screen where a summary of all past visits was shown in reverse chronological order containing only critical information. Visitation records were stacked in a way that doctors can refer to the overall summary and then go to the details of a specific OPD encounter or IP admission. When this concept was presented to the doctors, many of them were skeptical of the possibility of such a system.
“I actually evaluated – along with senior doctors – a couple of oncology-specific systems and we did not find it anywhere. We prepared the outline of such a system and designed the solution. It was then given to our HIS partner to build this system,” says the CIO.
The partner happily agreed and started preparing the building blocks of the system. A few doctors volunteered to try this new system out and gave inputs on how to improve upon it (for example, with pictures and annotations).
The project has been a runaway success. Today, the system has been adopted by more than 60% of the doctors at the institute. As per the CIO, the clinical advantages have been significant. There is 30% improvement in clinical productivity, significant reduction in medication errors, 30% reduction in waiting time between admission and start of the treatment and about 30% improvement in productivity of nurses.
“Our face-to-face interaction with doctors has been severely constrained due to COVID-19. Otherwise, we would have hit nearly 100% adoption. The chemotherapy module of the system actually defines the lower and upper limits of doses alerting the doctor in case of an error. There is an electronic verification of the bar code of drug at the time of mixing chemo drugs,” informs Dwivedi. He hopes the innovation will immensely help doctors, patients and the industry.
NOTE: JP Dwivedi won the dynamicCIO Innovative Heroes 2020 Award for this innovation