Max Healthcare improves patient safety with e-health record system

For a long time, hospitals in India have been manually measuring and monitoring the clinical parameters for patient safety. These include non-standard clinical diagnosis of patients, manual administration of various medicines for in-patients, manual monitoring of hospital-acquired infections, risk associated with delay in prophylactic assessment and treatment for Venous Thromboembolism (VTE) in all hospitalized patients etc.  

Manually measuring and recording the various parameters requires huge team of dedicated resources, and also runs the risk of manual errors. During the process there can also be cases of missing lab values or patient records. This adversely affects patient care continuity.

Max Healthcare decided to automate many of these areas and deploy standards-based diagnosis in Electronic Health Record system. That improved patient safety outcomes, minimised medication administration errors, significantly mitigated possibility of hospital acquired infections and reduced VTE risk by almost 80 per cent.

How was it achieved?

All diagnosis have an International Classified Diseases (ICD) coding system attached to them. In the absence of the standard coding system, effective analysis to link outcomes of patient care with clinical diagnosis was a very tedious task. The institute wanted to overcome these limitations by enhancing electronic health record (EHR) system, and leverage the electronic data available in the records to standardise clinical diagnosis processes and enhance patient safety outcomes.

“We found that among user communities, doctors are not the most amenable users to update the electronic health records. This is because of lack of time and the sheer volume of patients we have in the hospital networks. The goal of the project was to get electronic health records and update the system. We want to link and update the improvements to have better outcomes for the patients and aid research in future,” said Sumit Puri, CIO, Max Healthcare Institute.

It was made mandatory for all doctors in all departments to make an ICD-coded diagnoses entry on the EHR platform. The platform also enabled automated drug orders and administration using Bar Coded Medication Administration (BCMA). The clinicians enter data into the EHR system using specific templates for VTE risk prophylaxis and other clinical assessments. Using the Pentaho and Qliksense BI platforms the data was retrieved and algorithms were developed for  monitoring hospital acquired infections, VTE, BCMA etc. This collected data is then used to generate analytic reports.

“This ensured that standards were maintained across the departments, and real-time information of the patient is available. This leads to better service and enhanced safety metrics, “ added Puri.

Challenges

According to Puri, one of the biggest challenges in the implementation of the project was to have the large body of doctors adopt the change.

“This was a massive change in the system. We have a huge body of 3000 to 4000 doctors. Convincing, training and having the doctors use the system was our biggest challenge. It also required a certain level of sensitization across the nursing and paramedical staff,” said Puri.

Along with this, there was also a need for the top level management of Max Healthcare to push and make the usage of the EHR system mandatory across the departments as it not only gave the customers unique benefits but also gave lot of useful patient-safety related analytics to the company.

Benefits

The project helped Max Healthcare have a lot more standardised information with the data collected. “The more the clinical information, the better the treatment. This was also real-time information of the patients, that helped us understand and diagnose better. It also helped us reduce the chances of infection because of the knowledge base we had and the timely inputs in adverse cases, “said Puri.

The  EHR resulted in significant improvement of patient safety metrics, reduction of operational process errors, saving of man hours, and also ensured transparency.

The BCMA compliance percentage has significantly improved for Max Healthcare from 52 percent to 90 percent. In terms of VTE risk assessment of patients the increase was from 40 percent to around 80 percent. The rate of hospital acquired infections is now below global benchmarks and showing a downward trend.