Digitalisation in Healthcare for Patient Safety

Digitalisation in healthcare for patient safety has become a major factor in achieving high patient safety for medical organisations and professionals in recent years.

What does digitalisation in healthcare mean?

How does it differ from digitisation?

What is the way digitalisation can be utilised to improve patient safety?

What are the challenges faced by various healthcare organisations in implementing digitalisation?

Besides improvement in patient safety, what are the other advantages of digitalisation for the patients and healthcare providers?

These are some of the questions which arise in one’s mind, more so in the Indian scenario where the healthcare digitalisation is relatively newer.

Digitisation is conversion of an information from physical format to digital version for example scanning a doctor’s prescription written on paper and saving it as a pdf format. Whereas digitalisation is utilising technology to enhance various processes in an organisation, for example, writing prescription directly in electronic format. The digital transformation encompasses not just the digitalisation process but also the organisational change that accompanies it.

In this article, I will answer the following questions for everyone’s better understanding of utility of digitalisation for improving patient safety:

• How can digitalisation improve patient safety?
• What are the challenges in implementing digitalisation in healthcare?
• Besides patient safety, what are the other advantages of digitalisation?

Over the past two decades digitalisation in the healthcare industry has spread its tentacles to fascinate us all. Let us investigate ways or areas where digitalisation can be utilised in any healthcare system:

Most of the time EMR and EHR are being used interchangeably. But we need to understand the real difference between EMR and EHR. Electronic medical record is the digital version of a patient’s paper record like medical history, diagnosis, treatment entered electronically by any healthcare practitioner. EMR is not directly accessible to other practitioners within the organisation or outside the organisation or to patient himself. Whereas electronic health records (EHRs) are designed to encompass all features of electronic medical records (EMRs) generated in a healthcare organisation and go beyond the organisation which primarily collects the patient’s data. The information in EHRs can be shared with various specialists, other healthcare providers e.g., laboratories, other healthcare organisations and the patients themselves for a better coordinated and safer patient care. Information about a patient’s past and ongoing treatment, any allergies are easily accessible and prevent inadvertent errors. The patients themselves can track their own records at any point of time such as investigations done a year back or findings of any surgical procedures.

Most of the hospitals in India are using EMR as a form of digitalisation and very few have moved or are moving towards EHR. Although even EMR offers patient safety especially so in reducing medication errors because of legible prescriptions.

The Ministry of Health and Family Welfare, Government of India, had notified EHR standards for India in 2013 and revised it in 2016 with an objective to introduce a uniform standard-based system for creation and maintenance of electronic health records by the healthcare providers. National Digital Health Blueprint (2019) is one of the policies which the Government of India has formulated as a framework for implementation of digital health record systems all over India. Implementation of all such standards and policies will strengthen our healthcare system in terms of safer patient care.

Radio frequency identification (RFID) and barcode technology make accurate and reliable information readily available at the point of care and helps in preventing medical errors. All patient care activities right from admission and during the patient’s stay, can be tracked, e.g., specimen collection, monitoring medications, infusions etc. It is immensely helpful in preventing identification errors like wrong patient and wrong medication, wrong patient and wrong blood samples and so forth.

With RFID technology medical staff can pinpoint the location of any patient in the hospital to ensure their safety. Patient tracking is especially relevant in neonatal units, paediatric departments, mental health facilities, or for tracking geriatric patients.

Although telemedicine has been around for several decades with slower acceptance, we all have seen the spurt in its utilisation during Covid 19 pandemic. Nothing could have been safer in view of the need of social distancing. Being a clinician, my own apprehensions of doctors not physically examining the patient was gone during pandemic days. Online consultations provided a means of safer, cost effective and timely treatment methodology.

Even though the pandemic has slowed down, telemedicine is an option which is now being chosen by many because of its multiple benefits. Telemedicine provides options for safer treatment choices as the patients can have multiple specialists or a team of specialists’ opinion from different regions of a country or outside his or her own country. It also provides better patient and family engagement.

Most of the hospitals have been using paper formats for reporting of incidents which occur in any healthcare organisation. We all are aware of drawbacks associated with reporting incidents in paper format. Transparency issues, non-availability and non-accessibility of the format at all times, at every place and by all healthcare workers including clinicians, delay in circulation of the paper for root cause analysis and corrective and preventive actions by all concerned authorities are some of the drawbacks. To overcome these drawbacks, many of the private healthcare organisations now have digital mobile and desktop-based applications for reporting of healthcare incidents and errors. Even clinicians among their busy schedule can immediately report the incidents which they encounter, through their mobile apps. Photos as evidence can be uploaded in real time.

The software has the automated integration for information to concerned stakeholders with a provision for documentation of corrective and preventive actions. Data is analysed, trends seen, discussion done in various meetings and with management for improvement in systems and processes for a safer healthcare environment. In my own experience I have found these tools to be very user friendly and efficient in reduction in incidents like medication errors, patient falls etc.

Every healthcare organisation is implementing various quality accreditation standards in order to make the facility safer for the patients. Auditing plays a significant role in continuous quality improvement. Instead of a traditional method of auditing and documenting observations on paper, organisations are using digital auditing system software which have inbuilt standard and objective elements against which audit can be performed.

Auditing tools have the facility to automatically assign the scheduled audits to concerned auditors at defined interval. Observations are documented, pictures can be uploaded, action plans are made by the auditor and assigned to concerned stakeholders. An automated mail gets generated as an information for action taking and to any administrative personnel if required. Closure report is uploaded which again automatically sends the report to the auditor for acceptance or rejection with his or her comments. Data is analysed and comprehensive reports are downloaded for further discussion and system improvement.

I have used the digital audit tools with all the above features. The stakeholders are surprised and very happy to receive the automated reports on their email for action taking, analysis and further corrective and preventive actions in the system.

The business intelligence (BI) tools use medical software to safely and electronically gather, standardise, and manage patient information to improve patient care and decision-making. The healthcare providers can access comprehensive data, visualise trends and make faster decisions to provide timely care and hence improve patient safety.
Use of BI tools e.g., Tableau in my practice led to easier management of the data flow and actionable information. Multiple data trends could be clearly visualised and utilised for improving systems and processes for higher patient safety.

Multiple challenges like financial issues, manpower non-conversant with technology, low doctor patient ratio etc exist which prevent wider adoption of EMR and EHR in India. Lack of Integration and sufficient data for care continuity, patients’ lack of technical skills, expensive technology, privacy concerns, lack of insurer coverage of telehealth services, low or no reimbursement are some of the barriers to telemedicine. Financial constraints remain the main reason for non-implementation of technology like RFID, barcode system, business intelligence tools. Whereas cost and training issues are the main barrier to digital incident reporting and audit systems.

Digitalisation leads to a transparent, quicker and more organised system without any data loss, it’s less time and manpower consuming. Patient and healthcare organisations are benefitted in cost reduction. According to a pilot survey done by Soham Sinha, Srishti Majumdar and Arpita Mukherjee from June-October (2019) in 15 hospitals in India (private and government based) multiple perceived benefits of EHR adoption were reported. Survey participants pointed out that digitalisation can make healthcare more affordable, accessible, and equitable. It can contribute to economic growth, reduce reliance on imported medical devices, and allow for a more patient centric approach.

Digitalisation is the need of the hour as a key for high patient safety. It allows for a more patient centric approach and healthcare organisations can utilise the technology in multiple systems and processes to make patient care safer, affordable and easily accessible. The challenges faced in implementing digitalisation can be overcome by judicious planning and integrated approach with various stakeholders. Moreover, a broader vision for contribution towards the improvement of the healthcare system at the national level needs to be kept.