JIPMER Department of Medical Records Welcome all Delegates to JIPMER HIMA ASIA CONFERENCE-2017 One Patient, One Record and One Number from birth to death 27th & 28th October 2017

in Association with Health Information Management Association, India

Golden Jubilee Celebration of Medical Records Education and Execution in India

GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA About JIPMER

JIPMER originated on 1 January 1823 as “Ecole de Médicine de Pondichéry,” a medical school established by the French imperial government in India to train French citizens in Pondichéry. It was one of the earliest institutions of tropical medicine and the teaching staff consisted of surgeons and doctors of the French navy and troupes colones. Students who were trained here were granted a diploma called Médicin Locale that allowed them to practice medicine in the colonial territories. Under the French, the college was located in the heart of the town of Pondicherry in the modified buildings of the high court, opposite Le place de Gaulle, which is now the Legislative Assembly Hall. In 1959, SE Le Comte Stanislas Ostrorog, Ambassadeur de France aux Indes, laid the foundation stone of the new medical college building that was located on the outskirts of the town and, in 1964, the college moved to its new campus at Gorimedu. With the de jure transfer of Puducherry to India in 1956, the Government of India took over the college and renamed it simply Medical College, Pondicherry. For a short period, it was called the Dhanvantri Medical College and, on July 13, 1964, after Pandit Jawaharlal Nehru’s death on May 27, 1964, it was again renamed to “Jawaharlal Institute of Postgraduate Medical Education and Research” (JIPMER) (on 13 July 1964). Today, the institution is universally known by the acronym JIPMER. In 2008, JIPMER was declared as an Institution of National Importance by an act of Indian Parliament. In 2014, JIPMER started jipmer international school for public health (JISPH).

JIPMER is under the direct administrative control of Directorate General of Health Services (DGHS), Ministry of Health and Family Welfare, Government of India. The institute is headed by the director as the chief executive charged with overall responsibility of running the institute and the hospital. The dean helps the director coordinate all academic activities of the institute including teaching and research. The Medical Superintendent helps the director coordinate all the hospital functions pertaining to patient care. There are 28 academic departments headed by professors. Ancillary hospital service units are supervised by respective technical heads.

JIPMER was ranked sixth among medical colleges in India in 2017 by Outlook India[ and fifth by The Week. It was ranked fifth by Careers 360 in 2017, fourth among government institutes.

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About Health Information Management Association (HIMA) India

HIMA INDIA’s primary goal is to provide the knowledge, resources and tools to advance health information professional practice and standards for the delivery of quality healthcare. HIMA INDIA is in collaboration with International Federation of Health Information Management Associations (IFHIMA) is committed to advancing the HIM profession in an increasingly electronic and global environment through leadership in advocacy, education, certification, and lifelong learning.

The health industry is evolving quickly, and HIMA INDIA is working to advance the implementation and effective management of electronic health records (EHRs) by leading key industry initiatives and advocating for consistent standards. Needs are evolving from simply translating data, to having instant access to intelligence that can drive clinical and administrative decision-making in real time. HIMA INDIA ensures that HIM professionals are armed with the skills and tools to act with positive attitude as leaders, using quality information to achieve the triple aims of reduced costs, better care, and improved population health.

Browse our newly redesigned site to learn more about HIMA INDIA, how to join HIMA INDIA attending Association events, networking with HIM professionals, career opportunities with HIMA, and much more! Earning HIMA INDIA credentials at the later stages is under active consideration.

The purposes of HIMA INDIA are to:-

h promote the development and use of health records/information management in all health institutions including hospitals and health centers.

h advance the development and use of national health records/information management at par with international standards.

h provide for the exchange of information on health records/information management education requirements and training programs across the nation.

h provide opportunities for education and communication between persons working in the field of health records/information management in all the institutions of India and abroad.

h promote the use of technology and the electronic health records throughout the nation.

4 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA About Department of Medical Records, JIPMER

l In JIPMER Hospital, Medical Records Department has been established since its inception i.e., April 1966. This Medical Records Department provides facilities that, accurate and complete case records be written for all patient and filed in an accessible manner in the department. l Every day discharged records are collected and arranged in a chronological order and systematically classified and categorized including M.L.C. & Expired are preserved bythis department l Communicable and Non-Communicable, preventable disease details and monthly return are sent to the Public Health Agencies for Community intervention to take preventive and primitive measures. l Whenever this department receive the court summon, the relevant case records are submitted to the court in person or supplied to the doctors or sent through the post. l Statistical information collected from various departments and compiled for preparation of monthly Hospital Bulletin. (So far, 329 Medical Care Review Meeting / Morbidity & Mortality Meeting convened by this department under the chairmanship of Medical Superintendent / Director ) l Electronic Token system implemented at main block during September 2012 and at Super Specialty, W.C.H, and RCC block during December 2012. l Organized the Orientation Program on I.C.F. & I.C.D.-10 was conducted to the Medical Record Professional of various institutions including private college & hospitals of Pondicherry during 2010 and during 2013 to the residents of JIPMER and also conducting orientation program on “FUNCTIONS AND ACTIVITIES of MEDICAL RECORD DEPARTMENT” given regularly to the 1st year M.B.B.S. / Interns of out institution and other institutional trainees of Medical Record Technology. COMPUTERIZATION The outpatient registration made computerization from 19th august 1996. Then gradually the Admission Room, Census Desk and issuing of Laboratory Report are also computerized. The Computer Laboratory was established for conducting the M.R.O. & M.R.T. Training Programme during the year 2010. DIGITILIZATION AND ARCHIVING: Digitization of medical records works started during March 2010, last twelve years In-patient records (approximately 6.5. lacks) has been completed & it will be interfaced with HIS in future. Whenever there is need for old records from wards, it can be reviewed from HIS by the authenticated persons. EDUCATION AND TRAINING PROGRAM Apart from the patient care services this department is conducted the training courses like Medical Record Technician, Medical Record Officer and Bachelor of Medical Record Science since 1980. The Certificates and Diploma for the above courses were issued by the CBHI, DGHS under the Ministry of Health and Family Welfare, Govt. of India, New Delhi. Half yearly review meetings of CBHI, DGHS for the year 2010 & 2013 were conducted byour institution in Pondicherry. Almost 500 MRT Trainees, more than 100 MRO Trainees and 74 B.M.R.Sc., Trainees has been trained in this institute under CBHI.

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ORGANISING TEAM

Chief Patron Patron Chairman Dr. Subash Chandra Parija, Dr. Anita Rustagi, Prof. Dr. G.D. Mogli Director, JIPMER Addl Med. Superintendent, & President HIMA India JIPMER

Vice Chairman Convener Convener Organizing Secretary Dr. Anandraju Mittisila, Officer Mr. Subhakar Medepalli Mrs. Mallika Kothandaraman Mr. Lakshmanan. A In-charge -MRD, JIPMER General Secretary, HIMA India

Treasurer Treasurer Joint Secretary Mr. R. Moorthy Mr. G. Ravichandran Mr. N. Viswanathan Mrs. V. Vijayalakshmi Reception Committee

Mr. P. Santhanam Co-ordinator Mrs. Chandra Anbazhagan Mr. Sivagourounadin Accommodation Mr. Eben Jeya Roy Reception Committee Transport Committee Committee

Mr. Muthukrishasamy Mr. Manimegalai Mrs. Indoumady Mrs. Vijayavalli Recreation Committee Media Committee Food Committee Fund Raising Committee

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ORGANISING COMMITTEES

Scientific Committee Food Committee Recreation Committee • Dr. G.D. Moghli • Mrs. M. Indoumady • Mr. N. Mouthukrishnasamy • Dr. Anandraju Mittisila • Mr. S. Sakthivel • Mr. G.K.Baskaran • Mrs. Mallika Kothandaraman • Mr. N. Meigandan • Mr. N. Meigandan • Mr. A. Lakshmanan • Mr. B. Selvarasu • Mr. S. Narayanakumar • Mr. Kaliyaperumal • Mr. Muruganandham • Mr. S. Sivacoumar • Mr. Dhanaradjou • Mr. Kuttiyandi Accommodation Committee • Mr. P. Karunanithi • Mr. P. Santhanam Reception Committee • Mr. D. Dilin • Mr. G. Ravichandiran • Mrs. Chandra Anbazhagan • Mr. E.R. Raja • Mr. E. Shanmugarajarajan • Mrs. V. Vijayalakshmi • Mr. Kaliyamoorthy • Mrs. Muthulakshmi • Mr. S. Virapattirane • Mrs. S. Hemavathy Souvenir Committee • • Mr. Sandeepkumar • Mrs. P. Devipriya Mr. Vasudevan • • Mr. A. Dhanagopal • Mrs. V. Muniammal Mr. Muthukrishnan • Mrs. N. Bouvaneswari • Mr. S. Biju Kumar • Mrs. S. Anuja • Mr. S. Yuvaraja Transport Committee • Mrs. J. Selvi • Mr. T. Sivagourounadin • Mrs. P. Suganthi • Mr. S. Murugaiyan • Mrs. Kavitha Technical Committee • Mr. M. Madhan • Mrs. D. Sarodjini • Mr. Martin • Mr. M. Palani • Mrs. Nagamani • Mr. S. Biju Kumar • Mr. S. Saravanane • Mrs. Anjaladevy • Mr. S. Yuvaraja • Mr. H. Balasubramanian • Mrs. Meenakshi • Mr. Djearamane • Mrs. N. Amsaveni • Mr. B. Muthukumara Samy • Mrs. Hemadevi • Mrs. M. Vijimalar • Mrs. S. Sarasvady Financial Committee • Mrs. Ramani Carounagarane • Mrs. V. Vijayalakshmi • Mrs. V. Vijayavalli • Mr. P. Santhanam Media Committee • Mr. S. Virapattirane • Mrs. S. Soccammalle @ • Mr. K. Dakshinamoorthy Manimegalai • Mr. V. Vasudevan • Mr.S. Thillaiambalavanan • Mr. K. Narayanane • Mr. P. Virabaghu • Registration Committee Mr. S. Mounissamy • • Mr. R. Moorthy Mr. K.M. Bose • • Mrs. P. Kavitha Mr. A. Sanniyasi • • Mr. A. Martin Mr. Loganathan • Mr. Anand Kumar Dehariya • Mr. S. Bijukumar • Mr. V Murugaiyan • Mr. R. Rakesh • Mr. Munisamy (ems) • Mr. Rampal • Mrs. Lakshmi

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Contents Page HIM Professionals to Meet the Challenges of Revolutionized Health Care System 26 Weak Medical Records - An Invitation to Litigation 32 21st Century requirements for HIM Professionals 38 “The Health Information Technology (HIT) standards for Health Information Management (HIM) practices” 42 Adoption New Technologies & Communication System 46 Benefits and Challanges on Intra Operabilitiy 49 Future of HIM Education 54 Develop Comprehensive Medical Records Audit System 59 Birth to Death – Need of eHR for Population Health Surveillance System 70 Pace of Him Through Healthcare It.. 72 “From Paediatric Age to Geriatric Age a New Health Information Management System in 21St Century” 75 Personal Health Record (PHR) linking with EHR gets lifelong Health Information 80 QUALITATIVE Care Reviews 87 The Significance of the Transition to the Electronic Medical Record 96 Analysis of Trauma Patients Flow at JPN Apex Trauma Centre, AIIMS, New Delhi 99 Health Information Management role in Quality and Patient Safety 101 Challenges of EHR Adoption-Implementation 104 Interoperability in Healthcare: Benefits, Challenges and Resolutions 109 Development of Morbidity Coding in Indian medical systems viz., Ayurveda, Siddha and Unani in line with Chapter 23 on Traditional Chinese Medicine, W.H.O-ICD-11 114 Documentation and Management of Electronic Health Records 116 Electronic Medical Records, Healthcare, and the Patient 120 Advantages and Challenges with the Implementation of Electronic Health Record 124 Electronic Health Records - The 9-Step Implementation plan and Challenges for Health Centers 127 21st Century Requirements for Health Information Management (HIM) Professionals 130 “E-Health Record from Birth to Death globally” 136 Better Health Information Management for Digital India” 136 Proper Documentation and Good Medical Record Keeping: An Essential Part of Patient Care. 138 Walking through Healthcare Stress 142 Evaluation of Literature on Electronic Health Record System 143 “Checklist Manifesto- Using clinical protocols integrated with Electronic medical records to standardize primary care and ensure quality by Apollo clinics” 151 Life Health Record 152

8 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA Programme Schedule DAY - 1 Program Schedule (Friday 27th October 2017)

Time Topic Presenter 08.00 -09.00 am Registration 09.00 -09.50 am Inauguration 09.50 -10.20 am Coffee break 10.40-11.00 am Medtech Private ltd presentation 11.00 – 11.15 HIM Professional to meet the challenges of Revolutionized Prof. Dr. Mogli Healthcare System 11-15-11.30am Future of HIM Education Mr. Narendar Sampath Kumar, UAE 11.30-11.45 am 21st Century Skills in HIM - Mr. Jegannathan 11.45-12.00non 21st Century Requirements for HIM Professionals Mr. Vishwanathan Moderator: Dr. Shrimantha Kumar Dash- Kindly maintain 15 minutes timing 12.00-12.15 pm Medico Legal Cases Mr. Prabhakar, Hyderabad 12.15-12.30 pm HIM Role in Quality and Patient Safety Madhu Mohan Maddirala, Mumbai 12.30-12-45 am Develop Comprehensive Medical Audit System NipulKapadia Gujarat 12.45-01.00 pm Qualitative Care Review Mr. Keshava Rao, Bangalore Moderator: Dr. Radhika Madhavan – Kindly maintain 15 minutes timing 01.00-02.00 pm Lunch Break 02.00-02.15 pm Weak Medical Records Dr. Kusa Kumar Shah 02.15-02.30 pm Proper Documentation of good medical record keeping an Mr. Ramachandiran, Puducherry essential part of practice care 02.30-02.45 pm Advantages of one patient, one number, one record from birth Mr. Eben Jeya Roy, Puducherry to death 02.45-03.00 pm Pace of HIM Through Healthcare IT Mr. NageswaraRao Karri Vijayawada, AP Moderator: Dr. Mahesharam- Kindy maintain 15 minutes timing 03.00-03.30 pm Discussion on HIM Professionals (incl. HIM Education, Skills, Leadership, Characteristics Panel Members; Lt. Col Dr. Kamalakar, Mr. Marie Joseph, Mr. Ramachandiran, Mr. Prabhakar, Mr. Keshava Rao, Mr. Kakim Shariff M.M, Mr.N.Viswanathan 03.30 – 03.45 Coffee Break 03.45 – 04.00 Finding Calm I Midst of Chaos-A Quintessential Skill to Survive Dr. Kiran. USA the 21st Century Stress Moderator : Mrs. Mallika Kothandaraman 04.00 – 4.15 Discussion on MR Documentation (including what makes a good record; how it is done!)

Recommendation to Government: What Govt. should do to improve HIM systems and HIM professional status to get recognition like any healthcare provider) Panel Members: Prof Dr. Mogli,

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DAY -2 Program Schedule (Saturday 28th October 2017) Time Topic Presenter 09.00 -09.20 am Personal Health Records (PHR) linking with EHRR gets life-long Prof. Dr. Mogli Health Information 09.20 -09.40 am Standardization of Electronic Health Record Forms Lt. Col Dr. kamalakar 09.40-10.00 EHRR adoption and Challenges Mr. Yuvaraja Senthamarikannan 10.00 -10.15 am The Health Information Technology (HIT) Standards for Health Mr. Lakshmananan, A Information Management (HIM) Practice 10.15- 10.30 am eHealth Record from Birth to Death globally Mr. Md. Zakir Hussain 10.30-10-45 am An Overview of the significance of the transition to the electronic Mrs. Mallika Kodandaraman medical record 10.45 -11.00 am Benefits and Challenges on Interoperability Mr. Subrahmanyam 11.00-11.15 Softlink International Pvt. Ltd., Presentation Moderator: Mr. Ramalinga reddy Keshari- Kindly maintain 15 minutes timing 11.15 – 11.30 am Coffee Break 11.30 – 12.00 Discussion on Electronic Health Records (including implementation advantages & challenges- Panel members: Mr. Nageswara Rao Karri, Mrs. Mallika, Mr. Lakshmanan, Mr. Sheethal Johar,&. Mr. Zakir Hussain, Mr. Moorthy, Mr. Kishore Babu 12.00-12.15 pm Birth to Death -Need of eHR for population Health Surveillance Mr. Vijayakumar A. System 12.15-12.30 pm Interoperability in Healthcare Benefits & Resolutions Mr. Mohd. Shazman 12.30 – 12.45 pm One patient One Record One number Mr. Kalleshwar IT 12.45 – 01.00 pm Electronic Health Record System in Karnataka-Literature Review Mr. Sheetal Johar

12.30 – 12.45 pm Advantages and Challenges with the Implementation of Electronic Mrs. Chandra Anbazhagan Health Record 12.45 – 01.00 pm Electronic Health Records - The 9-Step Implementation plan and Mrs. Vijayalakshmi.V Challenges for Health Centers Miss. Anjana. O Moderator: Mr. Jebaraj Chelladurai, kindly maintain 15 minutes timing 01.00 – 02.00 pm Lunch 2.00 – 02.15pm Analysis of Trauma Patient Flow at JPN Apex Trauma Center, Mr. Ramesh Kumar Kaul, AIIMS, New Delhi New Delhi 02.15-02.30 pm Development of Morbidity Coding in Indian Medical Systems viz Mr Sheik Abdul Rahman, Ayurveda, Siddha and on Traditional Chinese Medicine -WHO- New Delhi ICD-11 02.30 – 03.00 pm Innovative Ideas presentation (best 6 ideas) 03.00-03.30 pm Recommendation to Government: What Govt. should do to improve HIM systems and HIM professional status to get recognition like any healthcare provider) Panel members: Prof Dr. Mogli, Mr. Subhakar, Mr. Madhu Maddirala, Mr. Narendar Sampath Kumar, Mr. Mahesh Babu, Mr. Rakesh Kumar Koul, Lt. Col Dr. Kamalakar and Dr. Kiran, Mr. A. Lakshmanan 03.30-04.00 pm Conclusion and Closing Ceremony Certificate Distribution

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Hon’ble Lieutenant Governor, Dr. Kiran Bedi, IPS, (Retd)

MESSAGE

I much delighted to know that the medical records department of JIPMER in association with the health information of association of India is organizing “JIPMER HIMA Asia Conference-2017”. I am happy to note that the national and international speakers are participating in this event.

World health organization (WHO) has defined health as not only devoid of disease but having social, emotional, moral and spiritual well being. Keeping this in view, information, knowledge and wisdom are necessary for health care professionals. It is indeed appreciable that this conclave aims at enlightening the delegates with regards to maintenance of electronic health records meeting in the international standards.

I hope this conference deals with universal health insurance schemes as well as looks at accessibility, availability, affordability and high quality health care for the population.

I extend my warm greeting and wishes to all health information management professionals in making this conference a grand success.

(Dr. Kiran Bedi)

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Hon’ble Chief Minister, Shri. V. NARAYANASAMY

MESSAGE

I am very pleased to note that the Department of Medical Records of The Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER) & Health Information Management Association (HIMA) India is conducting an Asia level Conference JIPMER HIMA ASIA Conference-2017 from 27th to 28th Oct, 2017 at JIPMER Auditorium, Puducherry so as to celebrate” Golden Jubilee (50 years) celebrations of Medical Record Education and Execution in India” This conference usually provide an opportunity for the Medical Record Professional to enrich their knowledge and skill in the field of Medical Record Technology. I came to know that there are delegates health professionals registered across India and also from abroad are participating JIPMER HIMA ASIA CONFERENCE-2017 This conference aims at enlightening the delegates with regards to the knowledge of technical advancements in maintaining international standards in hospitals and ensure that each patient has one medical record and one medical number I congratulate the organizers of this conference and I steadfastly believe that this conference will definitely provide an opportunity for the health information professionals to enrich their knowledge skills and updated on the advanced technology related to medical records and to recognize the need for safeguarding the health information and its legal aspects I extend my warm greetings and wishes to all Health Information Management professionals in making this conference a grand success

Shri. V. NARAYANASAMY Hon’ble Chief Minister

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Hon’ble Minister for Health Shri. MALLADI KRISHNA RAO

MESSAGE

I am very pleased to note that the Department of Medical Records of The Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER) & Health Information Management Association (HIMA) India is conducting an Asia level Conference JIPMER HIMA ASIA Conference-2017 from 27th to 28th Oct, 2017 at JIPMER Auditorium, Puducherry so as to celebrate” Golden Jubilee (50 years) celebrations of Medical Record Education and Execution in India” Health Information is a critical component of effective, high quality health care. Documentation of all information medical record system and system to analyse that information for better management are all ingredients of modern health care facilities. This conference provides a platform for HIM and IT Professionals, Doctors, Nurses, allied health care professionals to interact with each other on a wide spectrum of topics related to Health Information Management. With the introduction of IT in Health Care industry, it is necessary to discuss its implications in the Management of Medical Records, and its optimum utilization to enhance our efficiency and accuracy. I extend my warm greetings and wishes to all Health Information Management professionals in making this conference a grand success.

Shri. MALLADI KRISHNA RAO Hon’ble Minister for Health

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Dr. M.K. Bhan The President, JIPMER MESSAGE

I am pleased to note that the Department of Medical Records, JIPMER is organizing an Asian level “JIPMER HIMA ASIA CONFERENCE-2017” on Health Information Management for the first time in union territory of Puducherry in association with Health Information Management Association (HIMA) India. The aim of conducting this conference is to bring out the Technical advancements made in the field of Health information Management by eminent invitees and speakers not only from India but also from Abroad, which would benefit the participants in enriching their knowledge in Digital technology in health care, education, and interaction of professionals to enhance the digital knowledge in line with our Hon’ble Prime Minister’s slogan “DIGITAL INDIA”. The Organizing Committee has tried to do its best for the conference by putting in dedicated and committed hard work since the day it was decided to organize the same. I wish the conference all success and I am sure it will be benefitted for all delegates attending this conference from various parts of India and Abroad.

The President, JIPMER

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Dr. S.C. Parija, The Director, JIPMER MESSAGE I am happy to note that the Department of Medical Records, JIPMER & Health Information Management Association (HIMA) India is conducting an Asia level Conference “JIPMER HIMA ASIA Conference-2017 “from 27th to 28th Oct, 2017 at JIPMER Auditorium, Puducherry so as to celebrate Golden Jubilee (50 years) celebrations of Medical Record Education and Execution in India. The term “Medical Record” is a systematic documentation of a single patient‘s medical history and care across time within on particular health care provider’s jurisdiction. Accurate identification of a patient is the backbone of an effective and efficient medical record system. Correct identification is needed to positively identify the patient and ensure that each patient has one medical record number and one medical record. In the growth of scientific medicine, medical records have played an important role as a tool and basis for planning patient care besides medical education, research and legal protections. The medical record serves as the central repository for planning patient care and documenting communication among patient and health care provider and professionals contributing to the patient’s care. I must congratulate the organizing committee of this conference and I firmly believe that this conference will definitely provide an opportunity for the health record professionals in this unique platform not only to enrich their knowledge, skills, technology and get updated on the technological advancements related to medical records and health information management but also to enhance efficiency and accuracy.

(Dr. S.C. Parija,) The Director, JIPMER

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R.K. Swaminathan The Dean, JIPMER MESSAGE

I honestly appreciate the sincere efforts of the staff of Medical Records Department for organizing JIPMER HIMA ASIA CONFERENCE-2017 of Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER) & Health Information Management Association (HIMA) India is conducting an Asia level Conference from 27th to 28th Oct, 2017 at JIPMER Auditorium, Puducherry. The theme of this conference is” To Exhibit the latest in HIM solutions /products and technology designed by leading manufacturers” and “ To address certain specific needs of HIM from the Asia continent” in maintaining the Medical Records in the present scenario which deals the clinical applications, including registration, appointment, scheduling, clinical documentation and assessment, care planning, minimum data set, physician referrals, physician accesses, pharmacy, staffing, scheduling, result reporting, quality improvement, and medico-legal with vital statistical data enumeration My hearty welcome to all the medical and paramedical professionals, let all the participants in this conference from various parts of the world share experiences, exchange ideas, suggest developments in order to lead the best medical records system in a fitting manner. Let me make this opportunity to express my hearty congratulations to organizing committee for the exemplary works and wish the conference a great success.

(The Dean) JIPMER

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Dr. Ashok Shankar Bhade Medical Superintendent, JIPMER MESSAGE I am very pleased to note that Department of Medical Records, JIPMER is conducting JIPMER HIMA Asia Conference-2017 at Main Auditorium, JIPMER on 27th and 28th of October-2017. I sincerely congratulate the Organizing Committee of JIPMER HIMA Asia Conference-2017 for conducting the convention. This is a great honor and privilege to send the following message. The aspiration of the JIPMER HIMA Asia Conference-2017 during this conference will not only bridge the gap between medical records professionals, healthcare providers and information technologists, with the participation of professionals and students from the varied fields will add great value-how to meet the needs of patients, care providers, administrators, government and community as a whole to build up healthy society with the application of modern technology. This is a great challenge for our Medical Records Professionals in order to fulfill this, we have to adopt and apply our experience to accomplish the nation’s goal. Honesty, dedication and persuasion with positive attitude, harmony professional pride could pave the way for achieving JIPMER HIMA Asia conference solemn objective. The theme of the Conference “e-Health Record from Birth to Death Globally” one patient, One Number, One Record I extend my warm greetings and wishes to all Health Information Management professionals in making this conference a grand success

Medical Superintendent, JIPMER

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Dr. J. Balachander Former Medical Superintendent JIPMER & Professor Cardiology MESSAGE

I am pleased to note that Medical Records Department of The Jawaharlal Institute Of Post Graduate Medical Education and Research (JIPMER) & Health Information Management Association(HIMA) India is conducting an Asia level Conference, JIPMER HIMA ASIA CONFERENCE-2017 from 27th to 28th OCT,2017 at JIPMER Auditorium, Puducherry Health care quality and safety require that the right information be available at the right time to support patient care and health system management decisions. Gaining consensus on essential data content and documentation standards in a necessary pre-requisite for high quality data in the interconnected healthcare system of the future. Continuous quality management of data standards and content is key to ensuring that information is usable and actionable. Health information Management is experiencing a transition from traditional managing practices with paper to more efficient electronic management. But the main goal is still to analyse, manage and utilize the information that Is essential to patient care and making sure the information is accessible when required. I hope the knowledge shared by the participants would be utilized in practice for improving the Health Information Management systems. I extend my warm greetings and wishes to all Health Information Management professionals in making this conference a grand success.

(Dr. J. Balachander)

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Dr. Anita Rustagi, Addl. Med.Superindentent, JIPMER

MESSAGE

It is an honor for JIPMER to host HIMA Asia Conference 2017 (Health information management association of India) which is an Asian level conference. It is even more prestigious as this conference is to celebrate the Golden jubilee (50 Years) celebration of Medical Records Education and execution in India. Themes for this year’s conference is very opt e-Health record from birth to death globally (one patient, one number, one record) as the health tourism is one of the fastest developing sector. Also digital technology in Health care is the need of the aware. I hope that this two days conference would benefit the participants to update knowledge on Health information Management. I extended a very warm welcome to all faculty, delegates and participants and wish conference all success.

(Dr. Anita Rustagi) Addl. Med.Superindentent, JIPMER

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Dr. Madhu Raikwar Director, CBHI, DGHS, New Delhi

MESSAGE

I am extremely delighted to know that an Asia level conference on Health Information Management is being organized with the theme ‘eHealth record from birth to death globally’ during 27-28 October, 2017 at JIPMER, Puducherry. This is truly a remarkable occasion as it coincides with the Golden Jubilee Celebration of Medical Record Education and Execution in India. Medical record keeping reflects the entire health history of a patient and it helps in improving the efficiency and quality of care given to the patient. The Government is also trying to implement efficient Health Information System as envisaged in National Health Policy 2017 with the support of private sector and it would lead to the creation of patient registries with information on diseases and health events. Therefore medical record departments of hospitals will have a key role to strengthen the health information system of the country. In this era of digitization, your choice of the theme of the Conference is very timely and worth appreciation. I congratulate all for your efforts to make the program a great success.

Dr. Madhu Raikwar Director, CBHI DGHS, New Delhi

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Greetings Health Information Management Association – India

I send warm personal and professional greetings to you, particularly as you celebrate your 50th anniversary year of organizing.

The profession has seen tremendous change in these 50 years, but I dare say we will see even more in the next 50 years with the rapid digitization of records, artificial intelligence and machine learning being applied to the digitized data, and the trend of greater consumer involvement in their healthcare. I know you are seeing these trends at various stages of development in your country, and you are contributing to these changes as seen around the world.

Wishing you a wonderful convention and a great future!!

Lorraine Fernandes, RHIA President Elect, IFHIMA, 2016-2019

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Prof. Dr. G D Mogli, PhD MBA FHRIM (UK) FAHIMA (USA) Organizing Chairman and President of HIMA India Visiting Professor, Medical Informatics, MGIM Sciences, Sevagram, Maharashtra, India Ex. Associate Professor HIM Program, King Faisal University, Saudi Arabia Dean of Health Information Management (HIM) program, MOH, Oman Head of HIM Diploma Program, Kuwait Inst Of Health Sciences, Kuwait Head of BMRSc Degree Program, JIPMER, University of Madras WHO Consultant, Sr. eHealth Management, HEARTCOM (USA) CEO & MD Dr Mogli Healthcare Management Constancy, Sr. Medical Record Consultant / Adviser to the Ministries of Health, India, Afghanistan, Iran, Kuwait, Saudi Arabia, Oman, Bahrain, Qatar and UAE. [email protected] Phone: +91 9949750983 MESSAGE It’s a great pleasure to welcome health information managers and other related healthcare professionals across India and overseas to the conference. My personal message to our young Health Information Management (HIM) professionals are in combination of business, science and information technology that must meet medical, legal and ethical standards and generate proficient reports by analyzing database, ensuring integrity, security and confidentiality of patient data. provide data for swift, safe, improved quality and cost contained care. The HIM is a powerful profession which has brilliant role to play in healthcare organization and should be considered as honor and privilege to work in this field as it has hidden pleasure and influence to achieve the professional goals by following methods: To be effective manager, you must acquire, needed qualifications, skills, and positive attitude/behavior as part of leadership skills that will help in your managerial role. As part of healthcare team, you should note, despite, existence of various departments in the hospital, there is a huge gap that could be narrowed only by the health record manger as his department is closely linked with patient and his kith and kin from beginning to end of patient journey. Revolve around patient as a good coordinator and ensure that all his or her healthcare issues are resolved swiftly and judiciously by integrating with the concerned. Remember, “Your destiny as a good leader with in the hands of patients”. In view of government endeavor to standardize and implement all the healthcare institutions to accomplish unified EHR(Electronic Health Records)system for patients with information from birth to death, entail hundreds of HIM professionals to carry out the proposed system in the healthcare institutions. This requires establishment of adequate number of standardized and rationalized HIM program educational institutions in the country. The government with the partnership of private educational institutions and with HIM Association of India must contemplate opening new HIM institutions in the country to meet the required demand. It would be prudent to monitor consistently the set educational standards are maintained and potential graduates would be competent to perform their role efficiently to achieve government ambitious integrated healthcare plan. The HIMA India as a national association would be pleased to collaborate with the central and state governments in establishing a central HIM department in the Ministry of Health to be headed by a Senior HIM Professional to oversee the development of HIM programs in the country, assist in setting of national standards for medical records / health information management, Improve the quality of HIM professionals and HIM numbers, and initiating HIM educational and training programs to generate needed manpower, conduct workshops, seminars and conferences for the benefit of HIM and institutions. Develop HIM policies and procedures including, the budget, staff pattern etc. And participate and assist the government in improvement of healthcare delivery system and strive to advance the Health technology to meet dynamic progress of medicine for the nation. All this could be possible by establishing a HIM Council at par with medical, nursing, pharmacy to accomplish the set objectives. The medical record is the reflection of work carried out by healthcare providers and others. The Health Information Manager is custodian of health information and ensure the system is on track to meet the set goal of the institution. The HIM is vital department of the healthcare institution as such the government has to consider in right perspective to get the best of healthcare workers to provide best possible healthcare to the citizens and inhabitants of the nation.

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GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA HIM Professionals to Meet the Challenges of Revolutionized Health Care System

Dr. G.D. Mogli, Ph.D, MBA, FHRIM (UK) FAHIMA (USA) Visiting Professor of Medical Informatics, MGIM Sciences, Maharashtra Ex WHO Consultant and Sr. Consultant (eHealth Management) HEARTCOM (USA) Sr. Consultant Adviser to the Ministries of Health; India, Afghanistan, Iran, Kuwait, Saudi Arabia, Oman, Bahrain, Qatar and UAE [email protected] www.drmogli.com Introduction: It is foreseen that during the next decade, the present conventional environment of hospital, health centers clinics, will undergo complete transformation. The patient may not have to leave home for medical attention, nor will the doctor have to visit the patient. The internet will be used to input vital signs like pulse rate, blood pressure, heart rate, temperature, blood sample, x-ray, ECG, EEG, CAT scan, MRI etc., that would be processed by the regular desktop or mobile device through internet. Doctor’s prescription will be transmitting to the nearest pharmacy, and it will be delivered immediately. Digitization is the use of digital technologies that change a business or healthcare to provide value- producing opportunities; it is the process of moving to a digital business.Digitization in healthcare services will enable the govt to improve the overall health of the population through better targeted medical interventions and that doctors have immediate critical information available to be shared amongst their community/hospital network. This can be used for exchange of health information in an electronic environment, including health information exchange, electronic medical / health record. Artificial Intelligence (AI) has unimaginable potential. Within the next couple of years, itwill revolutionize every area of our life, including medicine. However, AI will prove to be the next successful area of cooperation between humans and machines that will redesign it completely for the better. AI could help medical professionals in designing treatment plans and finding the best suited methods for every patient. Today, a physician can log into Modernizing Medicine, find what rare condition it is, scroll through the treatment options available, and write a prescription in mere seconds. AI can help diagnose illness, offer novel treatment options, eliminate human error, and take care of all the repetitive tasks that clog up the system. AI Savvy hospital are deploying AI and its technologies brethren cognitive computing and machine learning in specific use cases at this point. 2. Revolutionized Healthcare System: Mobile nursing units and video conferencing will be very common; hence the patient and doctor may not be in the same city or country. Access to other patient with similar ailments on a mutually consensual basis with anonymity, if desired, would be possible. Electronic chips or bands on patients to monitor vital signs of the patients round the clock, with this doctor’s inputs, will be automatically logged into the patient’s record. There will be only one medical record for a patient from birth to death containing vital information such as vaccination, drug reactions, current medication being administered, etc., which can be accessed globally. Electronic chip will be used to administer exact dosage on schedule and to observe the feedback from the patient. Doctors, instead of writing or recording will just speak into the medical record (voice recognition software will convert it into the text and store it in an audio file). Diagnosis will be more accurate, due to new sources of information through internet. Minimal hospital stay would be required as treatment will be administered at home with the doctor monitoring using electronic devices

26 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA over the internet. Benefits of a single online medical record are huge. Doctors gain insight on cause of diseases by cross-referencing other patient’s records and those of relatives. This can also help in discovery of causes, prediction of trends etc., Availability of inference engines (online chatting) on the Internet that will diagnose based on answer to the questions will prevent doctor’s visit for minor ailments. Global health insurance will ensure the availability of care from any country without leaving the shores, especially remote /rural areas. Some of new start-up companies are working with new innovations related to AI and machine learning is as follows: Google Deep-mind to mine medical records to provide better and faster health services; can process hundreds of thousands of medical information within minutes. Through such data, hospitals can improve the quality of care, while patients could also get a clearer picture about their health. When smart algorithms tell people, they are going to be sick even before they experience the symptoms. Laboratories and researchers with its robotic microscopes and machine vision to generate better view about tissues. And 3Scan’s machine is so efficient that it can undertake a tissue sample analysis in one day that it would take a pathologist to do in one year using traditional methods. It can predict through its Zeus algorithm based on combination of clinical, labs, demographic and behavioral data, how likely a patient will be readmitted to a hospital. AI can also prevent recidivism, by helping follow cases and make further recommendations as time rolls on electronic medical records are imbued with AI. A physician using them will occasionally get a pop-up explaining how certain genetic traits might affect their patient’s illness or how a new drug could improve their condition. AI helps doctors assess the health risks of a patient and then uses the intelligence to not only improve the quality of care, but also monitor and advice patients on the side effects of certain medications. The impact of AI across the globe is disruptive, with technologically advanced tools enabling better decision- making, diagnosis, and treatment of chronic and acute illnesses. The implementation of the technology in healthcare in the Middle East has disrupted the current situation to follow the global evolution of healthcare where technology assists in early disease detection, early diagnosis, and effective diseases management and treatment. Artificial intelligence allows doctors and other medical professionals to make more accurate and faster diagnosis. In medicine, AI uses mathematical algorithms and data-science from the human body to make diagnosis, better than doctors can do. This gives specialists the ability to take immediate actions for diseases that may otherwise become severe. The role AI in the early diagnosis of diseases and prevention premature deaths is invaluable in saving lives of patients diagnosed late. AI helps in reducing the cases of human errors and has proven to have positive impact on reduction in mortality rates by improving the efficiency of disease diagnosis, disease management and treatment. AI is a promising technological advancement that promises a revolution in the healthcare system for a better future in the industry. AI in combination with robots has led to positive changes in care, without a replacement of the human doctors and nurses. As such, its application has shown that the technology is only an ingenious complement to doctors as opposed to replacing them. With the positive reception of AI in the Middle East, and particularly in Kuwait, the future of this technology is very promising. The biggest fear is that AI will become so sophisticated that it will work better than the human brain and after a while, it will aim to take control over our lives. Stephen Hawking even said that the development of full artificial intelligence could spell the end of humans. Elon Musk agreed. These changes can be implemented effectively provided the management and the professionals are well equipped with the growing technology. The need of the hour for the health record profession is to provide the expected services in a fast-changing environment and to reap the benefits that accrue-in terms of better healthcare, preventive, curative, promotive and rehabilitative by using latest technology.

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Anticipated Medical Practice: Patients will be more healthcare conscious instead of going to hospitals or outpatient clinics, or GPs, will use the following centers according to their need and preference taking economical, social and environmental convenience: The centers are headed by specialist of each field with authorized expertise and licensed to practice. Hospital size will be reduced to minimal and mainly for varied surgical procedures. Similarly, there will be different surgical specialty hospitals where surgical procedures are carried out. The traditional practice of medicine will undergo marvelous transformation; there will be centers like gasoline stations or major hotels; in each city, town and villages too. The types centers encompass: Creation of personal health record (PHR) with proper biometric identification and maintaining healthcare data; birth and death registrations, child development and welfare centers for immunization and child growth; Self-care medical & treatment centers, Medication prescription centers, Investigation diagnostic centers, hospitalization centers, obstetrics & gynecology centers, therapy centers with the support of mobile technology, video conferencing and consultations will be very common. Theses centers can function isolated way or in a group similar to polyclinics. The medical, nursing profession will undergo spectacular transformation; paramedics with their highly professional knowledge and skills will play pivotal role in dealing with patient and healthcare management system. Each professional working for health field need to equip with highly sophisticated knowledge and skills in compatible with the advancement made by digitization, artificial intelligence and machine reading mechanisms. 3. Role of HIM Professionals The HIM Professionals has a vital role in the fast-revolutionized healthcare system. His role encompasses in overseeing digitization of technologies, artificial intelligence and machine learning, transformation of paper record into paperless, ensuring safety of patient with technology, roleof biometrics in healthcare privacy and security 3.1 Roadmap for Successful Implementation of Electronic Health Records (EHR): Goal Setting: In any development program, usually, five issues become apparent; (1) the proposed plan (road map), (2) the people involved (3) the process (the systems and procedures, (4) the technology that will be core and the last (5) budget (adequate finance). The main theme of this presentation is the process of development and successful implementation of EHR. Implementation Time Schedule:Experience has shown that some organizations have accomplished their EHR implementation on schedule with the active participation and collaboration of staff while other organizations have met enormous struggle and could achieve partial success or no success at all. Implementation Teams: The Team should identify people with required characteristics and supervising skills to manage. Training of team members is paramount importance. It is necessary to have a training curriculum that covers the EHR’s software configuration, workflow analysis and redesign, and user training and support one-week classroom training, three weeks of self-directed learning in specially arranged areas. Training needs to be given just in time a week or two weeks before go-live to be effective. The Process (the systems and procedures): One of the most important criteria of the policy makers is to determine whether, the organization will go for in-house (tailor-made) software or vendor (ready made) software. (Needs assessment à Design à Design- Validation à System Build à System Build Validation à Implementation). Phased Implementation is the stepwise introduction of EHR functionality through a series of phases, each with its own analysis, training, and go-live schedule.

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The technology: Infrastructure including hardware, software, network, cabling etc., is a vital part of EHR success. Ensure that required hardware, network system is in place. The software for the organization has multifarious purpose such as outpatient, emergency, day-care surgery, admissions, inpatient care, ICU, CCU, NICU, OT, laboratory, radiology, pharmacy, nursing and so on and to review the software generally, and especially by different groups with meticulous precision; point-to point confirmation of the functionality, to ensure that the software that acquired and installed would satisfy the initial needs as prepared prior to obtaining the EHR software. There is a need to back up the data daily and have a working disaster recovery plan. Budgeting: Creating special budget exclusively for implementation of EHR whether it is in-house tailor-made or vendor ready-made is most vital. Conclusion: The successful implementation of EHR brings sea of functional changes and this could be feasible only when uninterrupted blessings of the policy and decision makers are there. 4. Amalgamation of Manual Records (MR) with Electronic Health Records (EHR): 4.1 Introduction: Most of the global health organizations, especially hospitals are swiftly moving from paper to paperless and in this process, many conventional paper based hospitals are also fully engaged in transforming the manual records to electronic. The organization should have a clear vision, mission and objective for amalgamation of manual records into electronic. Establish a hybrid health record steering committee to guide the organization from a paper to electronic environment. 4.2 Definition of Hybrid Health Record: Dr. Mogli defines “A hybrid health record is one where some records are maintained manually and some records are automated. Precisely, some hospitals have both the systems practiced side by side and combination of both the systems either partially or fully is considered to be hybrid”.

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Scanning of Records: Scan medical record charts and paper medical records to digital format. Scanned document images are converted using Optical Character Recognition (OCR) services to convert patient’s record to electronic health record (EHR) format for integration to EHR software and conversion of scanned documents into PDF, Word and Excel Files.

5. How safe is Patient with Technology? The healthcare is a great challenge to all healthcare organizers and providers in view of wide range of patient safety problems worldwide. The patient safety can be defined “as the condition ofbeing safe, freedom from danger or hazard or risk or injury and adverse effects, exemption from hurt, or loss. Freedom from whatever exposes one to danger or from liability to cause harm, or loss, hence the quality of making safe or secure or giving confidence, justifying trust, insuring against harm or loss etc., happening to a patient as part of systematic relevance of data obtained from incident reports, from any healthcare organization and learning from near miss and adverse events to facilitate in either eradicate or minimize the adverse outcome is called patient safety”. Most of the current evidence on adverse events comes from hospitals, because the risks associated with hospital care are high, but many adverse events also occur in other health-care settings, such as physicians’ offices, nursing homes, pharmacies and patients’ homes. Major safety issues that occur in every level of patient, every point in the process of registration, specimen collection, analysis, or investigation process, care giving contributes a certain inherent lack of safety, side-effects of drugs or drug combinations, hazards posed by a medical device, substandard or faulty products entering the health service, human shortcomings, or system failures. Airway fires during surgeries and burns while investigations such as EKG or MRI. The information Technology (IT) plays a vital role in reducing the errors, improving care coordination, enhancing efficiency, dipping duplication, and increasing the amount of time dedicated to directing patient care. Clinical information systems can have a profound impact on patient quality, outcome and safety. Several studies have shown that physicians who had access to clinical practice guidelines and features such as computerized reminders and alerts were far more likely to provide preventive care than were physicians who did not. 6. Role of Biometrics in Healthcare Privacy and Security Management System Introduction: The healthcare system in the process of transformation to provide swift, safe, improved quality and cost contained care, is experiencing multifarious problems such as passwords are meant to protect computer network systems from unauthorized use, but they also may provide a false sense of security. Another aspect is the use of health records that are mixed up, incomplete or misplaced information, wrong medication, and patient information into another patient’s record. Because of the inherent weakness of password systems, other identification systems have been developed. Biometric identification systems employ use biological data, in the form, e.g. Voice, faceand signature scans, the most common physiological biometric include finger-scan, retina scan, hand-scan, and iris-scan. Biometric identification cannot be forgotten or stolen and involve the use of IT to acquire, analyze, store, manage and transmit genetic data. In US, since April 2009, in view of HIPAA requirement that physicians and healthcare professionals who use EHR track every time a patient’s record is accessed. Bioterrorism and Public Health: Biometrics could be very helpful in two important ways. Firstly, the biometric-identification of terrorists can be distributed electronically to all potential risk areas within and outside nation for preventive purpose. Secondly, it can help in detecting the disease, if effective, would substantially reduce the mortality, morbidity. The new trend in public health is driven by the need for early warning system, detection of surreptitious biological attacks. The trend is likely to accelerate

30 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA because evidenced is accumulating that these new approaches work–that they can detect outbreaks earlier than existing methods and even identify outbreaks that have previously gone unnoticed. The HIM professionals: play a vital role in effective and efficient delivery of healthcare. There is an acute shortage of HIM professionals despite there is a huge demand. Modification of HIM traditional education: In view of emerging technology and implementation of electronic health records, the conventional responsibilities of HIM department will diminish and need revision of HIM traditional education to corporate competing syllabus to generate innovative HIM leaders on modern lines to meet the new challenges of maintaining paperless records. In order to produce innovative HIM professionals to meet the needs of 21st century, it is imperative that education program must encompass with most pioneering theoretical and practical program in the HIM education. Dramatic change in health information management demands new thinking, about howwe educate tomorrow’s professionals. Redefining roles, competencies, and educational progression should be the foundation of College of HIM Education. When tomorrow’s graduates enter the HIM workplace, they will have to be ready for the e-HIM environment. And the HIM program objective should be to develop curriculum that would meet the HIM professional who after successfully completing the Bachelors’ degree in HIM should be able to: Endow with knowledge and skills necessary to become self –directed learners. Solve problems by critical thinking Attain informatics skills, communication and inter personal skills. Instill a commitment to life-long learning, and important ethical values. Foster the acquisition of leadership abilities. Adapt careers within changing health care environment. Serve society and the profession through collaborative practice. Provide innovative teaching by generating and application of new knowledge Conduct research devoted to HIM in an electronic environment Carry out activities that are focused on evolving the strategic and operational relevance and robustness of clinical information resources of healthcare industry & PH sector. Participate actively in quality and performance improvement management Collaborate and cooperate with IT department in developing EHR Conclusion :The Need of innovative HIM éducation with mock-up lab and practical training to encompass the syllabus and course content to enable the HIM student to gain utmost knowledge, skills and required attitude to deal with the latest technology and challenging issues faced by the healthcare system. HIM Professional have to work with passion, dedication, and have to widen their focus and broaden their horizons. Everyone has to prove their skills and to provide vision to the organisation with leadership rôles and be part of the senior management team to support them in providing facts for business opportunities. This Can be achieved by having continuous audits and quality assurance programs involving all the healthcare providers. Although technology is taking over traditional methods, HI Managers have to bé vigilant with their educational background and Professional expertise to update their knowledge and skills with continuos education to meet the new innovation that is happening in revoluationized healthcare system.

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Weak Medical Records - An Invitation to Litigation

Dr Kusa Kumar Shaha Additional Professor & HOD, Forensic Medicine & Toxicology, JIPMER - Puducherry - 605006 Email - [email protected] Mobile No - + 91 9442070703

Abstract Proper handling and maintenance of medical records can save the doctor from many unpleasant situations and have proven of great help in medico legal matters and in cases of negligence suits filed against the medical practitioner. With the increasing use of medical insurance for treatment, the insurance companies also require proper record keeping to prove the patient’s demand for medical expenses. Improper record keeping can result in declining medical claims. The paramedical and nursing staff also should be trained in proper maintenance of patient records. For both care and legal purposes, medical record must be complete, accurate, and available when needed. It is wise to remember that Poor records mean poor defense, no records mean no defense. Key words: Medical records, medical practitioner, medico legal expert, record keeping, patient, medical negligence

Introduction Medical Record is the collection of information concerning a patient and his or her health care that is created completely, legibly and maintained either paper based or electronic in the regular course which they provide to their patients. Medical records are documentary evidences in the eyes of courts of law, which are of immense help not only in medico legal cases but also in defending the doctor in cases of negligence suits or allegations against him/her. However, doctors because of their busy schedule, either don’t maintain records or records are kept very brief, incomplete, cryptic records which are of no use in court matters. 1. The technical, medical and legal knowledge of preparing, keeping and maintaining medical records is an essential art to be known to every medical practitioner. What is the importance of the Medical Records? India is slowly becoming a litigant society. In many of the occasions the allegations are either proved or disproved only on the basis of the well kept or ill kept medical records. Medical records are not only of great help in medico-legal matters, but also they form an essential data of patient’s history, illness, treatment, prognosis etc. which are essential in research and advancement of medicine. They also act as statistical data used for formulating public health guidelines and health policies of a nation.

What is the purpose of the Medical Record? Medical records are an integral part of good quality patient care. The primary purpose of the medical record is to facilitate patient care and allow you or another practitioner to continue the management of the patient. Clinical observations, decision making and treatment recommendations or plans should be recorded contemporaneously. This reduces the possibility of an error occurring and is an important risk management tool.

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Essential ingredients of a good Medical Record Accurate medical records are an integral component of a defense to investigations, claims or complaints. Chronology is essential and close attention shall be given to assure that documents are filed properly, and that information is entered in the correct encounter record for the correct patient, including appropriate scanning and indexing of imaged documents.2Whether in paper or electronic format the medical record must contain: Comprehensive documentation of patient history, complaints and symptoms, examinations, and laboratory and imaging reports copies of emails or other communication with the patient, related to clinical care and follow-up, including documentation of telephone consultations or prescriptions copies of operative procedures, consultation reports, discharge summaries and other information created by other physicians or health-care practitioners which is relevant to the patient’s medical care Avoid criticism of other professionals in chart notes, otherwise triggers a high numberof unmeritorious law suits. What is legally required to be included in a medical record? All entries must be accurate statements of fact or statements of clinical judgement .Personal (non- medical) opinions should not be included. explain the reason for the visit, provide the history and record of any examination, investigations, diagnoses, treatments, and medications, and include a follow-up plan. Only abbreviations or expressions which are generally understood in the medical community should be used. Discharge notes The discharge summary should mirror the case notes of the patient records with a brief summary, relevant investigations, operative procedures, instructions to be followed by the patient and date of next follow-up are useful when the sequence of events is an important issue in litigation later. The doctor can be held negligent if proper instructions are not given and the need for urgent reporting if an untoward complication happens before the advised time of review. It is not uncommon to have patients who gets discharged against the advice of the doctor. These patients are also entitled to have a discharge summary about the course of treatment. This document has to be retained along with the patient records. It will help the doctor in situations where the patient alleges negligence later. Referral notes Referral notes are an important component of patient records include the date and time of issue, the patient’s general condition, cause of reference, and the course of action to be taken. It is wise to keep a duplicate copy of the referral note with the patient’s signature which can save a doctor who could be sued for alleged late referral after the patient’s condition deteriorated. How the records are to be prepared and maintained Maintenance and Legibility of Record Currently, the Medical Record is considered a hybrid record, consisting of both electronic and paper documentation. Medical records should not be filed in alphabetical order. All Medical Record entries should be made as soon as possible after the care is provided, or an event or observation is made. An entry should never be made in the Medical Record in advance of the service provided to the patient. Pre- dating or backdating an entry is prohibited. Handwritten entries should be made with permanent black or

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blue ink, with medium point pens. This is to ensure the quality of electronic scanning, photocopying and faxing of the document. All entries in the medical record must be legible to individuals, Scribbling must be avoided. Corrections and Amendments to Records Incomplete or altered records create room for suspicion. When an error is made in a medical record entry, the original entry must not be obliterated, and the inaccurate information should still be accessible. The correction must indicate the reason for the correction, and the correction entry must be dated and signed by the person making the revision. Write “addendum” and state the reason for creating the addendum complete it as soon as possible with the date and time. If a patient requests a correction of their personal information in the medical record, andthe physician is in agreement, it must be made as soon as reasonably possible. The corrected information must also be provided to each organization to which the personal information was disclosed during the year before the date the correction was made. If a patient requests a correction of their personal information, and the physician is not in agreement, the requested correction must be documented along with the reason for declining to make the correction. Physicians must never alter a medical record after a complaint or legal action has been initiated. Completion, Timeliness and Authentication of Medical Records A. All inpatient Medical Records must be completed within 14 days from the date of discharge B. All operative and procedure reports must be completed immediately after surgery. C. All Medical Record entries are to be dated, the time entered, and signed. D. Certain electronic methods of authenticating the Medical Record, including methods such as passwords, access codes, or key cards may be allowed provided certain requirements are met. Confidentiality Confidentiality is an important component of the rights of the patient. The Medical Record whether paper or electronics confidential and make very sure that they are accessible only to the authorized persons in accordance with ethical, professional and legal requirements that meets expected standards for this purpose. The patient can claim negligence against the hospital or the doctor for a breach of confidentiality. Doctor will be held liable if he/she discloses the records or the contents to any unauthorized person or without the consent of the patient. Who May Document Entries in the Medical Record: Multidisciplinary Notes Clinical and social services providers may document entries in the Multidisciplinary Notes section of the Medical Record: Who owns and took the Responsibility and Security of Medical Record? MEDICAL RECORDS are considered the PROPERTY OF THE HOSPITAL and the PERSONAL DATA is considered a CONFIDENTIAL COMMUNICATION and the PROPERTY OF THE PATIENT. Medical records shall be maintained in a safe and secure area. Safeguards to prevent loss, destruction and tampering will be maintained as appropriate. The information contained within the Medical Record must be accessible to the patient and thus made available to the patient and/or his or her legal representative upon appropriate request and authorization by the patient or his or her legal representative within 72 hours. Failure to provide medical records to patients on proper demand will amount to deficiency in service and negligence charged for professional misconduct.

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Exceptions to this rule include the use of the information: • by doctors and other health professionals for the continuing care of the patient; • for medical research where the patient is NOT identified; and • for the collection of health care statistics when the individual patient is NOT identified. Under Sec 104 of Cr.P.C. Courts have power to summon any medical record. Special care must be exercised with Medical Records protected by the State laws covering mental health records, alcohol and substance abuse records, reporting forms for suspected abuse and HIV- antibody testing and AIDS research. When must physicians provide medical records to other physicians or health-care practitioners? Where two or more physicians are sharing the care of a patient A referral of a patient to another physician When patients request transfer of their medical records to another physician or other health-care However, transfer of medical records for the purpose of continuity of patient care must be done promptly and must never be delayed pending payment. Transfer of a medical record must also be documented in a written contract that includes the location, safe custody, protection of confidentiality, the patient’s right of access, duration of retention and appropriate destruction When must physicians provide medical records to lawyers, insurance providers or other third parties? A physician must provide a copy of records when provided with a written, dated authorization from the patient or the patient’s legal representative specifying the records that are to be provided. Original medical records must never be provided, only copies. How long must physicians retain medical records? All Medical Records are retained for at least as long as required by State law and regulations. The consumer protection act and Medical Council of India advises to preserve the in-patient records for five years and out patient records for three years. Even though the records need not be kept beyond 2 years, as the limitation period for filing a case in consumer court is 2 years. Cases can be filed beyond 2 years period, provided the delay can be explained to the satisfaction of the consumer court. 5 Medico-legal records to be kept for at least period of 30 years or up till the cases are decided in the court of law whichever is earlier, even though it is so difficult to keep them for such a long period. It is important to note that in pediatric cases a medical negligence case can be filed by the child after acquiring the age of majority. In the event that an original Medical Record cannot be located, a temporary medical record folder will be created. However, this limitation period starts only after the patient comes to know the effect of the alleged negligence on the part of the doctor. Unfortunately, it is difficult to be definitive about the applicable limitation period, as courts generally have a discretion to extend it in certain circumstances. When transitioning to an EMR, how long must physicians keep the paper medical record? Once the information has been fully transitioned to an EMR, it is not necessary to retain the original paper record. If only part of the paper record is transitioned to the EMR, then the remainder of the paper

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record must be retained as part of the original medical record. Scanned copies of paper records must be saved in “read-only” format. Can physicians destroy medical records after the legal retention period? Medical records may be destroyed when the legal retention period has expired but this must be done appropriately. Physicians must destroy medical records by supervised cross-shredding, incineration or by electronic erasure of data, including any backup copies of the records. What must physicians do with medical records that are still within the legal retention period when they retire or leave practice? Medical records which are still within the legal retention period must be transferred to the custody of another physician, public hospital or health authority. Judicial decisions in India on issues of medical records The hospital and doctor were guilty of deficiency in service as case records were not produced before the court to refute the allegation of a lack of standard care. The plea of destroying the case sheet as per the general practice of the hospitals appeared to the court as an attempt to suppress certain facts that are likely to be revealed from the case sheet. The opposite party was found negligent as he should have retained the case records until the disposal of the complaint. The State Commission held that there was negligence as the case sheet did not contain a proper history, history of prior treatment and investigations, and even the consent papers were missing. The National Commission in another case held that the hospital was guilty of negligence on the ground that the name of the anesthetist was not mentioned in the operation notes though anesthesia was administered by two anesthetists. There were two progress cards about the same patient on two separate papers that were produced in court. Instances in which Medical Records are used as Legal Evidence Medical records are generally used in court for the following: Insurance Cases Criminal Cases Worker’s Compensation Assault cases Personal Injury Claims Violent or unexplained death Malpractice Claims Sexual assault cases Will Cases Mental competency Procedure for the Release of Medical Information in a Legal Case Requests from lawyers are usually registered and date of receipt of request recorded by the hospital administration and forwarded to the MRO for processing. The medical record is located and the patient’s signature checked against the signature on the consent form in the medical record. The MRO notifies the hospital administration that the report has been sent. In most cases, the report is all that is required. If the actual medical record is needed, the lawyer must produce a court order of subpoena to enable the release of the medical record. Procedure for Preparing a Medical Record for Court If a subpoena or court order is served, it MUST BE OBEYED and release of the medical record to court.

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The MRO should check that all necessary information, as specified in the subpoena, is in the medical record and that it is complete. All pages (forms) should be numbered in ink and the total number of pages recorded on the folder, Send the original and keep a photocopy on file. When the original medical record is returned to file, the copy is removed from file and destroyed. To protect the privacy of the patient the medical record copy MUST be treated with the same respect as the original A form of receipt should be prepared for signature of the receiving officer of the court. The medical record should be forwarded under adequate security to the Clerk of the Court named in the Subpoena and the signed receipt is obtained from the person accepting delivery. If the medical record has not been returned to the hospital by the specified date, the MRO must check with the court to find out if the court case is over. If it is, they will request the prompt return of the medical record or, if not, ask the probable date of completion. On return from court, the medical record is checked to ensure that all pages (forms) are present. Conclusion Medical records are the integral part of medical practice/ medical profession that help the treating physician to prove in negligence suits that he / she has used while treating the patient and service given were consistent with good practice of health care and proper skill. Maintaining and preserving them in a proper and methodical way is the responsibility of the concerned doctor and hospital. They also form medical database of the region in particular and country in general useful while tabling health policies. In the present digital era every effort shall be made to computerize the medical records, which are fairly well protected for the purpose of safety and easy retrieval. The records that are the subject of medico-legal cases should be maintained until the final disposal of the case even though only a complaint or notice is received. Remember that honest and best maintained records will save you from crisis and claims not just once but all the times. It will act as a passport to prove his or her innocence in any alleged medical negligence. Reference: Purnapatre S S, Sahani Bimal, Sethi Kunal; Medical records for doctors – a must, Doctor in the court. 2004; 1: 03. For Patient Safety and Physician Defensibility - A Handbook for Physicians and Medical Office Staff Records Manual: A Guide for Developing Countries, WHO Library Cataloguing in Publication Data Medical Thomas: Medical records and issues in negligence, Indian Journal of Urology | July-September 2009 | Consumer protection act (CPA / COPRA) 1986 [amended in 2002]. Gupte S, Records and Documents. Documentation, Record keeping & Consent. Module III, Symbiosis Centre for Health Care, Study material, 2001-2001,15-24. Medical Council of India regulations. 2002.s1.3, sub-s1.3.1 and 1.3.2. Kanaiyalal Trivedi v Dr. Satyanarayan Vishwakarma 1996 (3) CPR 24 (Guj); I (1997) CPJ 332 (Guj); 1998 CCJ 690 (Guj) S.A.Quereshi v Padode memorial Hospital and Research Centre II (2000) CPJ 463 (Bhopal). Force v. M Ganeswara Rao . 1998 (3) CPR 251; 1998 (1) CPJ 413 (AP SCDRC). Meenakshi Mission Hospital and Research Centre v. Samuraj and Anr.,I(2005) CPJ 33 (NC) Thomas J. Medical records and issues in negligence.Indian J Urol 2009;25:384-8.

37 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA 21st Century requirements for HIM Professionals S. Jeganathan, Senior Manager, Medical Records, SIMS Hospital, Vadapalani, Chennai-600026

Health information management (HIM) is information management applied to health and health care. It is the practice of acquiring, analyzing and protecting digital and traditional medical information. to providing quality patient care. of HIM. Health information management (HIM) is information management applied to health and health care. It is the practice of acquiring, analyzing and protecting digital and traditional medical information vital to providing quality patient care. With the widespread computerization of health records, traditional (paper-based) records are being replaced with electronic health records (EHRs). The tools of health informatics and health information technology are continually improving to bring greater efficiency to information management in the health care sector. Both hospital information systems and health human resources information systems (HRHIS) are common implementations Health information management professionals plan information systems, develop health policy, and identify current and future information needs. In addition, they may apply thescience of informatics to the collection, storage, analysis, use, and transmission of information to meet legal, professional, ethical and administrative records-keeping requirements of health care delivery. They work with clinical, epidemiological, demographic, financial, reference, and coded healthcare data. Health information administrators have been described to “play a critical role in the delivery of healthcare in the United States through their focus on the collection, maintenance and use of quality data to support the information-intensive and information-reliant healthcare system”. HIM standards began with establishment of AHIMA Health information management’s standards history is dated back to the introduction of the American Health Information Management Association, founded in 1928 “when the American College of Surgeons established the Association of Record Librarians of North America (ARLNA) to ‘elevate the standards of clinical records in hospitals and other medical institutions.’”[4] In 1938, AHIMA was known as American Association of Medical Record Librarians (AAMRL) and its members were known as medical record experts or librarians who studied medical record science. The goal was to raise the standards of records keeping in hospitals and other healthcare facilities. The individuals involved in this profession were promoters for the successful management of clinical records to guarantee accuracy and precision. Over time, the organization’s name changed to reflect the evolving field of health information management practices, eventually becoming the American Health Information Management Association. The association’s current name is meant to cover the wide variety of areas which health professionals work in today. AHIMA members affect the quality of patient information and patient care at every touch point in the healthcare delivery cycle. They often serve in bridge roles, connecting clinical, operational, and administrative functions.[5] Electronic health records Electronic health record. The Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM)

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The electronic health record has been continually expressed as an evolvement of health record- keeping. Because it is electronic, this means of record keeping has been both supported and debated in the health professional community and within the public realm. Health information managers are charged with the protection of patient privacy and are responsible for training their employees in the proper handling and usage of the confidential information entrusted to them. With the rise of technology’s importance in healthcare, health information managers must remain competent with the use of information databases that generate crucial reports for administrators and physicians. Educational programs The requisites and accreditation processes for health information management education and professional activity vary across jurisdictions. In the United States, the CAHIIM requires continued accreditation for accredited programs in health information management. The current standard is that accreditation may be maintained with periodic site visits, submission of an annual report, informing CAHIIM of adverse changes within the program and paying CAHIIM administrative fees.HIM students may opt to participate in a full-time bridge program called the Joint Bachelor of Science/Masters Program. With this program, students can achieve both the Bachelor of Science in Health Information Management and the Master of Health Services Administration Program (BSHIM/MHSA). The full-time bridge program allows students to achieve both degrees in five years. Students pursuing the BSHIM/MHSA will be prepared to assume management and executive positions in health-related organizations such as: hospitals, managed care organizations, health information system developers and vendors, and pharmaceutical companies, and bring their knowledge in HIM to these positions. In Canada, graduates of Canadian Health Information Management Association (CHIMA) programs are eligible to write a national certification examination to pursue a profession in HIM. Online program availability There are many programs that are also available online. Online students collaborate with in-class students using internet technology. With online learning, students are allowed to go through the programs at their own pace. Online students are included in class through group lectures that are recorded and put online, discussion boards and are members of group projects with in-class students. Some online students are even allowed to attend some classes on campus and take some classes online. The CAHIIM lists accredited online programs on its website. Further education for Health Information Professionals Education is an important aspect in being successful in the world of health information management. Aside from initial credentials, health information professionals may wish to pursue a Masters of Health Information Management, Masters of Business Administration, Masters of Health Administration, or other Masters programs in health data management, information technology and systems, and organization and management. Gaining further education advances the health professional’s career and qualifies the individual for upper-management positions. Improving healthcare quality, reducing medical errors, reducing health disparities, and advancing delivery of patient-centered medical care; Reducing healthcare costs resulting from inefficiency, medical errors, inappropriate care, duplicative care, and incomplete information; Providing appropriate information to help guide medical decisions at the time and place of care;

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Ensuring that meaningful public input is included in development of such infrastructure; Improving the coordination of care and information among hospitals, laboratories, physician offices, and other entities for the secure and authorized exchange of healthcare information; Improving public health activities and facilitating the early identification and rapid response to public health threats; Facilitating health and clinical research and healthcare quality; Promoting early detection, prevention, and management of chronic diseases; Additionally, telemedicine technologies and technologies that provide home health monitoring of patients expand the landscape of privacy and security concerns. The potential for the use of new aging services technology to assist the aging and disabled population will continuously change the demands on HIM professionals to adapt privacy and security protections for patient information. Patient information is often collected off-site from the facility and electronically transmitted to the facility and incorporated into the facility EHR system. These changes in healthcare delivery challenge the HIM professional to adapt privacy and security policies and procedures to a rapidly changing healthcare system. HIM professionals can adopt two strategies to overcome these challenges to the privacy and security of health information. First, HIM professionals should make certain that the practice of health information management complies with the laws that cover the various involved domains. Whenever they have a chance to participate in the design, development, or implementation of an information platform for managing and sharing health information, privacy and security should always be the top priority. Without such a mindset and persistence, privacy and security will be a second thought during the process of design and development. On the other hand, HIM professionals should act as educators to consumers by showing them the proper way to access their health information while also maintaining the confidentiality of their records. Consumers need to recognize the advantages of information security from the perspectives of authentication, authorization, and auditing in a digitized environment as compared to a paper environment. They need to understand there is always a tradeoff between confidentiality and accessibility. The essential requirement is that the information be kept integrated and made available to the right person in a timely manner for the purpose of providing care. Health Information Management Health information management (HIM) professionals have skills and competencies in health data management, information policy, information systems, administrative and clinical work flow. HIMis focused on operations management—essential to ensuring an accurate and complete medical record and cost effective information processing. In acute care hospitals, HIM is often part of the team including the Information Technology (IT) staff and clinical informatics professionals that oversee electronic health records (EHRs). HIM skills are critical to continuous quality improvement, regulatory requirements, and revenue cycle processes, ensuring the availability of accurate health data. The role of HIM in helping medical practices adopt electronic health records is growing and is an ideal skill set for EHR technical assistance. HIM is a value-added “bridge” between clinicians, payors, regulators, patients, consumers and technology (EHRs, personal health records), with critical skills and competencies essential to building the nationwide health information network (NHIN) and health information exchanges (HIEs). For the purposes of program accreditation, the curriculum views the discipline of health informatics through the lens of three major facets or domains: • Information systems are concerned with such issues as information systems analysis, design, implementation, and management. • Informatics is concerned with such issues as the structure, function and transfer of information, socio-technical aspects of health

40 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA computing, and human-computer interaction. • Information technology is concerned with such issues as computer networks, database and systems administration, security, and programming. These three facets are aligned for the purpose of meeting the information needs of the various stakeholders within health care and related systems. Components of each of these facets are highly interactive with each other, requiring knowledge and skills that are shared between them. The result is a critical synergy within the discipline of health informatics. An educational program in health informatics must include content from all three facets although programs may choose to emphasize one or more facets consistent with their mission, goals and objectives. Better Tests There is little point in investing heavily in curriculum and human capital without also investing in assessments to evaluate what is or is not being accomplished in the classrooms. The first challenge is the cost. Although higher-level skills like critical thinking and analysis can be assessed with well-designed multiple-choice tests, a truly rich assessment system would go beyond multiple-choice testing and include measures that encourage greater creativity, show how students arrived at answers, and even allow for collaboration. Such measures, however, cost more money than policymakers have traditionally been willing to commit to assessment. And, at a time when complaining about testing is a national pastime and cynicism about assessment, albeit often uninformed, is on the rise, getting policymakers to commit substantially more resources to it is a difficult political challenge. Producing enough high-quality assessments to meet the needs of a system is education and training in 21st century. None of these assessment challenges are insurmountable, but addressing them will require deliberate attention from policymakers and 21st century skills proponents, as well as a deviation from the path that policymaking is on today. Such an effort is essential. Why mount a national effort to change education in HIM if you have no way of knowing whether the change has been effective. Conclusion The point of our argument is not to say that teaching students how to think, work together better, or use new information more rigorously is not a worthy and attainable goal. Rather, we seek to call attention to the magnitude of the challenge and to sound a note of caution amidst the sirens calling our political leaders once again to the rocky shoals of past education reform failures. Without better curriculum, better teaching, and better tests, the emphasis on “21st century skills” will be a superficial one that will sacrifice long-term gains for the appearance of short-term progress. Curriculum, teacher expertise, and assessment have all been weak links in past education reform efforts—a fact that should sober today’s skills proponents as they survey the task of dramatically improving all three. Efforts to create more formalized common standards would help address some of the challenges by focusing efforts in a common direction. But common standards will not, by themselves, be enough. The past few decades have seen great progress in education reform in the United States—progress that has especially benefited less-advantaged students. Today’s reformers can build on that progress only if they pay keen attention to the challenges associated with genuinely improving teaching and learning. If we ignore these challenges, the 21st century skills movement risks becoming another fad that ultimately changes little—or even worse, sets back the cause of creating dramatically more powerful schools for INDIAN students, especially those who are underserved today. We must see that the students of HIM must learn the latest developments in Medical Records by studying the HIM courses either in India or in abroad. It will be very expensive, if we study HIM course from abroad. So we have to start HIM courses through the Ministry of Health, Government of India. So we have to coordinate with the Indian Government to set up schools or colleges for HIM students. The syllabus and the curriculum should be the same for everybody.

41 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA “The Health Information Technology (HIT) standards for Health Information Management (HIM) practices”

A. Lakshmanan, M.A., M. Sc., M.R.O., PGDCA STATISTICIAN cum DEMONSTRATOR, JIPMER HOSPITAL, Puducherry- 6. (Mobile: 9626201199) Email:[email protected]/ [email protected]

Introduction: Integrate the Healthcare Enterprise (IHE) is an international initiative to promote the useof standards to achieve interoperability among Health Information Technology (HIT) systems and effective use of Electronic Health Records (EHRs). IHE provides a forum for care providers, HIT experts and other stakeholders in several clinical and operational domains. The “HIT Standards for HIM Practices,” describes the need for, value and an approach for aligning HIM practices with capabilities of standards-based HIT products to support information governance in healthcare. Its aim is by using standardized interoperable Health Information and Communication Technology (HICT) in healthcare for improving patient safety and quality of care with the concept of “One Patient - One Number-One Record for lifetime of Birth to Death”. Need for HICT Implementation: HIM professionals documented while transitioning from the paper-based to an electronic environment, there is a need to establish cross-collaboration between HIM professionals, standards developers and HIT vendors focusing on the following three efforts to assure that: Effort1:Functional requirements for HIM practices have been Communicated to standards developers for creating HIT Standards Effort 2: Standards are adopted in the HIT products and Effort 3: Standards-based HIT products support HIM practices. OBJECTIVES FOR HICT ADOPTION Demonstrate the alignment between HIM practices and capabilities of HICT products to support these practices Inform IHE development process by defining Profile Specifies checklist (i.e., functional requirements for HIT standards) aligned with the HIM practice checklist Inform the development of national and international HIT interoperability standards for HICT products for identified HIM practices and Create the roadmap for the development of these standards. SCOPE OF HICT ADOPTION. The HIT is focused on HIM practices related to electronic health information capture, management, sharing and use. We developed a methodology for cross-collaboration between HIM professionals and

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HIT standards developers concentrating on Method 1: a systematic approach for specifying functional requirements for HIM practices via use cases in order to validate existing HIT standards and to guide the development of new standards. Method 2: We anticipate working with the IHE community on expanding our approach to focus on HIT standards adoption in HIT products Method 3: Providing feedback on capabilities of standards-based HIT products to support HIM practices. PROJECTION OF AUDIENCE of HIM PRACTICE The audience of the HIM Practice includes > HIM professionals, > HIM educators, > standards developers, > HIT and ICT vendors for all types of clinical, > Public health and research information systems and > HICT products, and > other stakeholders involved in current or planned implementation of HICT in healthcare, Public health and research organizations. 1) Responsible of HIM Professionals in Health Care System HIM professionals are responsible for ensuring the availability, integrity, and protection of information that is needed to deliver healthcare and population health services and to make appropriate healthcare and health promotion-related decisions. Create, Enter, Classify, Validate Code, Examine, Store Delete, Deprecate, Record, Dictate Analyze Analytics, Business, Preserve Destroy Write QC/QA Intelligence, Release, Archive Permanent Store Receive Compliance Discover, Hold, Protect Discover Interface Integrate Retain, Export, Permanent Archive Update Prove Transmit, Exchange, & Transition Capture Maintenance Share

The potential roles for HIM professionals in the new interoperable electronic data sharing environment include Standards setters, Standards developers, Educators, Chief information governance officers, Consumer information advocates, Brokers of information. 2) HIM Practices HIM practices are focused on collecting health information, ensuring complete documentation, maintaining and protecting health data, and appropriately sharing authorized information through electronic as well as paper-based release of information. Thus HIM practices include various activities aimed to support basic HIM functions: Capture, Process, Use, Store, and Dispose health information.

4) Health Information is a Product Quality health information is a product of activities involved clinician, patient and HIM professionals. It is comprised of all types of health data generated in the process of care delivery within an episode of care and assembled/presented/stored/exchanged in records that include documents/data acquires/ screens/images/readings, etc.

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Relevant paper-based documents provided by patient, care providers and/or clinicians during the episode of care can be scanned and become part of the record of the episode of care. The order of performing these functions is determined by the type of encounter and specified by organizational policies or jurisdictional law. Each of these functions is associated with capturing/producing/sharing/ using specific information in the records.

Episode of Care’s Functions Examples of Information in the Record Visit Registration/Admission Patient and Facility Demographics, Billing, Consent Triage Triage Notes and Vital Signs History, complaints, Medication, Provisional Diagnosis and Assessment Care Plan Laboratory and Diagnostic Consent for Procedure, investigation & Reports Diagnosis and Care Plan Final Diagnosis and Updated Care Plan Prescription Medication Order and Dispense Report Progress notes Daily Treatments, Interventions, Procedures, etc. Summary of Care Discharge (or) Case Summary Discharge/Transfer/Disposition (ADT) End results and Follow up Advice Record 5) The Hierarchy of the Record Contents Such As: I ) Lifetime Record (prenatal care –birth – life – death): Longitudinal record that includes records from all episodes of care over the patient’s lifetime. II ) Episode of Care Record : Multiple information components generated within various functions of the episode of care. III) Function’s Record Component: Specific record(s) generated within a specific function of the episode of care. IV ) Data Entry Record: Representation of data in a record component associated with a specific function. 6) HIT Standards Developed by Standards Development Organizations: HIT standards developed by standards development organizations which may be applicable to HIM practices. Identifying standards from the following: International Organization for Standardization (ISO) American Society for Testing and Materials (ASTM) and Health Level Seven (HL7). Health Level Seven (HL7) Standards: 1. HL7 Community-based Collaborative Care (CBCC) Workgroup: Enable review of the Patient Friendly Consent Directive and Data Provenance Model to incorporate recommendation from HIM professionals 2. HL7 EHR Workgroup: Enable review of the HL7 EHR Functional Model standard to incorporate recommendation from HIM professionals 3. HL7 FHIR (Fast Healthcare Information Resources) Workgroup: Enable review of EHR System Functional Model - Record Lifecycle Events Implementation Guide to incorporate recommendation from HIM professionals

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Requirements HIA in HL7 1) Ability to capture and maintain information in timely, accurate, and efficient access EHRS FM R2 and retrieval. 2) Ability to search, identify, locate and retrieve patient specific information. 3) Ability to access information across various systems. 4) Ability to assemble information from disparate electronic systems. CDA R2 5) Ability to address multiple demands by Rt.I-Act. EHRS FM R2 6) Ability to access information created with legacy hardware and software systems. 7) Ability to maintain metadata services across all participating systems assigning EHRS FM R2 structural and descriptive characteristics. 8) Ability to ensure levels of redundancy, failover, contingency and other risk management practices. 9) Ability to maintain the workforce capabilities and turnover. EHRS FM R2 10) Ability to enable trust of requestor in information. CDA R2 INFORMATION GOVERNANCE Information governance is described as an accountability framework that “includes the processes, roles, standards, and metrics that ensure the effective and efficient use of information in enabling an organization to achieve its goals.” Record keeping principles include: 1. Accountability 2. Transparency 3. Protection Record Attributes 4. Integrity 5. Compliance 6. Availability 7. Retention Record States 8. Disposition ADVANTAGES OF HICT IN HIM PRACTICES: • Helps us to eliminate paper records • Faster registration and documentation processing • Locate the patient records instantly and accurately • Reduce the Space Problem for storage of Patient Records • Easy to storage and retrieval of patient records. • Patient information documented with consistency. • Integration with medical, Medical Record and laboratory professionals. Conclusion: I hope that the above said information about “the HIT standards for HIM Practices” have shared with you to get some knowledge for implementation of Health Information Technology on Health Information Management Practice in field of Health Organization System with the concept of “One Patient-One Number-One Record for life time from Birth to Death”, Especially in the field of Electronic Health Records Management system for registration, accurate documentation, locating, storage and retrieval of patient information.

45 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA Adoption New Technologies & Communication System Mr. Y. Eben Jeyaroy, M.A., B.Ed., B.M.R.Sc., (Retired), Medical Records, JIPMER. Regional Co-ordinator HIMA, India. Consultant in Medical Records (Teaching & Training) Medical Record Department, JIPMER Hospital, Pondicherry - 605 006. India. Contact No. 04142/290600. Mobile No. 09442545565

Medical Records • A Medical Record is a collection of recorded facts concerning a particular patient and is the documentary evidence of the care given to the patient. • To be complete, the Medical Record must contain sufficient information to clearly identify the patient, to support the diagnosis, justify the treatment and to record the results accurately. Providing the best medical care to the patient and providing materials for • Teaching and Training • Service Statistics • Research • Appraisal of Medical Practice • Legal Requirements This is the basement of Medical Records Communication and ethics. SIX EXCELLENT GUIDELINES FOR HOSPITAL STAFF IS • Courtesy • Commitment to Service • Presentation • Attention • Competence • Timelines. • Information, Communication and Technologies can really impact and improve the quality of care that we render to our patients. Management of patient information during the administration of emergency care is essential to avoid adverse events and assist in decision making. • Studies have shown that proper implementation has got significant benefits in improving better patient safely. The shared EMR is important when there is a multi disciplinary management of the patient and different care providers are involves.

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DEFINITION OF COMMUNICATION: • The process by which we understand others and in turn endeavour to be understood by them • Communication is an interaction and should lead to • Change • Transformation • Healing Growth------> Medical Records is a process. PROCESS OF COMMUNICATION: • SENDER->ENCODE->CHANNEL->MESSAGE->DECODE->RECEIVER->FEED BACK • “People Forget, Record Remember” • PERCEPTION OF THE LISTENER (Patients, Colleagues, Co-Workers) • Be open minded and get to know him better first • Be aware of the needs of the listener • Confirm their level of comprehension WHY COMMUNICATION IMPORTANT? • Build relationships • Communication is Everlasting-Human Life Mission • Medical Records is a Master Communication- What makes formal organizational communication effective • System approach • Clear, comprehensive and thorough documentations • Training • Culture • Supervisor-driven systems • Evaluation - Medical Records is a key part of Information & Transformation TYPES OF NON-VERBAL COMMUNICATION: • Facial expression • Eye contact • Gestures • Personal appearance • Tone and volume of voice • Body language • Touch • Silence

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Medical Record-good interpersonal relationship should start within the department. To do this he must have qualities of fairness, dependability and dedication and should command the respect of the employees under him By -> Motivation of the individual, Building Of Team Work. • Communication is the process of passing information to others, and understanding others, and good communication is essential for good relationships with good communication - misunderstandings can be avoided or cleared. The Medical Record professional as a manager should develop communication skills and be always willing to understand his subordinate problems. • The Medical Records department can contribute much to good public relations; contact with the public should leave a good impression. Special care must be exercised in the release of information. ASPECTS OF EFFECTIVE COMMUNICATION: • Voice • Appearance • Facial expression • Medium MEDICAL RECORDS ROLE • Frequent letters to the patient. • Keep up the register properly • Properly use in computer for Information Statistics and research study. • Intrapersonal Communication is the preparation for an effective interpersonal communication. • Quality of the intrapersonal communication depends on the intimacy with God. • “The way you see yourself influences the quality of your interpersonal communication and the effectiveness of your ministry”.(self esteem). “When we do the same things in the same way we get the same results. When we do the same things in the same way and expect better results. We have symptoms of insanity”. -Stephen Corey “Some men see things as they are and ask why? I dream of things that never were, and ask why not? -George Bernard Shaw (To be a Good Communicator, you must be a Good Listener) • A Mental process of Receiving, Understanding, Responding is the foundation of Medical Records Ethics. CONCLUSION: • The quality of formal and informal communication among the staff of a Healthcare Organization is closely linked to that between staff and patients. Effective internal communication is essential for successful external communication. COMMUNICATE------CARE------CURE

48 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA Benefits and Challanges on Intra Operabilitiy V.Subrahmanyam (Suresh) Manager Admin/MRO KIMS Hospital, Amalapuram Contact No.: 8297771110 E_mail ID: [email protected]

INTRODUCTION Electronic Health Records play significant roles in the improvement of patient care and the reduction of healthcare cost by facilitating the seamless exchange of vital information among healthcare providers. Thus, clinicians can have easy access to patients’ information in a timely manner, medical errors are reduced, and health related records are easily integrated. What is Operability? Operability - is ability of computer systems or software to exchange and make use of information. It is the ability to keep equipment, a system or a whole installation in a safe and reliable functioning condition, according to pre-defined operational requirements. What is Intra? Intra- is a prefix used to form words that mean on the inside, or within a group or groups. Intra + Operability = Intraoperability? Intraoperability, describes the exchange of data between systems that are fundamentally the same, and generally developed by the same vendor. Intraoperability strictly focuses on operations within certain parameters, so there’s little need for custom extensions. So what does Intraoperability mean for healthcare? Many EHR vendors have used their flexibility and customizability as a core benefit, but this often has the unintended consequence of poor intraoperability. True EHRs in the cloud, can better enable intraoperability because of their ability to avoid custom extensions. All applications should have the capability to connect, send and receive information spanning organizations and applications. By creating an environment where information can not only be shared, but then compiled, analyzed and made actionable, organizations will be able to improve the delivery of healthcare by making the right data available at the right time to the right patients. A health system or provider group may decide to create or implement a single EHR across all of its settings, enabling the quick and easy access of information across the care continuum—to be intraoperable. But the data would only be accessible by providers on that particular system without a parallel focus on interoperability. Should a patient see a provider in a surrounding, unaffiliated network, this information would not be easily accessible and may affect the quality or appropriateness of care provided. It’s worth noting that a crucial component of interoperability is the ability of health information systems to work together within and across organizational boundaries. So intraoperability could be viewed as a subset of interoperability. Need for Intraoperability:

49 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA

There is a need for transportability that will enable the internal stake holders an easy access to the latest patient records. e.g. The doctor’s scribbling pad which contains investigations list should be accessed at lab/ radiodiagnosis and similarly the prescription should be accessed by pharmacist for dispensing medicines. The ID band /ID card of patient should be sufficient for query in any corner of the hospital for getting services promptly and accurately. There is a need for personal health record (PHR) which contains the patient health information which could be available online to any authentic healthcare provider to decide TREATMENT IN CONTINUITY for the patient recovery. There is a need for containment of cost by developing a more systematic approach to healthcare information transportability where all disciplines work together towards a documented, integral approach to the individual patient. BENEFITS: For Patients: Allows patients to access their medical records anywhere resulting in faster communication with the provider, reduced doctor visits, remote submission of test samples, and access to test results on personal devices anytime. Integration and Improved access to information By using UMR or UHID, Patients can more easily access their records from their healthcare providers and track their own health. Improves Healthcare for the Chronically ill Patients from the easy access to medical records through interoperability Savings of repeated tests/investigations on change of doctor or when going for a second opinion. Transparency in healthcare provided at certain provider For Healthcare Providers: Physicians can access specific information regarding the patient’s health in order to consult with and accurately diagnose someone, thus reducing medical errors and misdiagnoses. Intraoperability allows different systems and applications of healthcare industry to communicate with one another, which lets healthcare providers access and integrate the information Fully standardized healthcare information exchange Improved physician workflow , productivity and timely patient care ensures patient safety Real-time information results in better patient outcomes as it enables providers tomonitor chronically ill patients and provide on time intervention to save patient’s life CHALLANGES: System compatibility The healthcare system is an information-based enterprise that generates a large amount of data from various systems and applications. All technology systems would understand each other completely if the same or compatible

50 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA terminologies were used. Data Integrity Incorporating information from independently developed applications is difficult because each application has its own data sources Information management throughout different healthcare systems entails collaboration, transferability and integration. This makes it more challenging for physicians to construct a holistic picture of the patient’s health. Different systems may have separate definitions of the same medical concept. This incompatibility makes interoperability difficult. Information Confidentiality Another reason why providers are wary of adopting intra operability is the risk it might bring to the confidential health data. Even the individual and owner of the health record and vulnerable relatives may have to be isolated from certain facts, which may worsen the recovery process, if revealed Confidentiality is required for ensure quick recovery of patient, keeping certain facts unknown, since emotional reactions may disturb mental status of patient and worsen the case. Information Access Control A patient’s medical information may become fragmented among various proprietary systems throughout these healthcare sources, making it difficult for one provider to access information originally documented by another. Non-uniformity of state healthcare privacy rules adds to providers’ concerns when it comes to exchanging medical records across the state lines. Hidden costs High cost of Enterprise systems Prohibitive system costs have deterred providers and clinical settings from achieving interoperability as EHR systems may require multiple customized interfaces to work with multitude platforms. The providers are to pay the associated more costs. Costs involving training of manpower to adopt the system Costs of software and infrastructure maintenance Costs of data warehouse maintenance HR Competency Resistance to change and lack of support by healthcare staff Difficulty with data entry due to lack of computer literacy Integration / Interoperability of medical devices Consolidating records spread across hospitals

51 JIPMER HIMA ASIA CONFERENCE - 2017

GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA Future of HIM Education

Narendar Sampath Kumar MBA, CHRIM(UK), CCA,CCS Health Information Manager Mediclinic Middle East, Dubai, UAE

History of Medical Records It is said that the history of medical records run parallel with the history of medicine. In the growth of medicine, medical records have played an important role as a tool and as a basis for planning patient care, providing a means of communication between the doctor and other professional groups contributing to the patient’s care; furnish documentary evidence of the course of illness and treatment of medical care rendered. In the recent past, Medical Records has undergone tremendous changes to suit the needs of present day medical revolutions. Medical Records Education & Manpower Development To have properly trained medical record manpower, the need for properly planned medical record education has become crucial. Medical Records Education dated back early 1930s with American Medical Record Organization (AMRO) developing educational programs in USA and various institutes in Canada and UK focus on training staff on Medical Records Policies and Procedures. Improvements in organization of Medical Record Services The greatest improvements in medical record services derived from the hospital standardization movement in 1918 and ultimately led to improve organization of medical record services and medical record staff. By the onset of 20th century, a more vigorous and wider acceptance of the utility and function of accurate and complete patient case records became apparent in the United Kingdom. The evolution changes in healthcare in Western Countries greatly contributed to the scientific formulation and development of accurate and complete medical records. No acute care hospital existed without a medical record department and its services. Among the most significant mile stones and landmarks in the recent history of medical record science are: 1, Organization of national medical record associations, the USA (1928), Canada 1942), Great Britain (1948), Australia (1952), India 1972) and so forth. As an evolution of medical records, the medical record administration has become health information management. In perspective of India In India, Medical Record Pioneer Dr. Mogli who is a great visionary has realized the need for qualified HIM professionals was so huge, there was an acute shortage and dire need of health records/information management professionals across the country. To meet the requirement of healthcare delivery system including primary, secondary and tertiary care at all levels of the nation through improving health record information management system, for which adequate professionals are were needed to manage HIM departments in all the health institutions.. He has put in lots of efforts in initiating and developing Medical Record curriculum, and deliberating with the state and central government to start a Medical Record Educational Programs in India in sixties and seventies starting with certificate, diploma, PG diploma and ultimately developing a bachelor of medical record science (BMRSc) degree program in the year 1980, in Jawaharlal Institute of Medical Education and Research (JIPMER), Pondicherry affiliated with the university of Madras first of its kind in entire South East Asia. This is right platform to celebrate the Golden Jubilee (50 years) of education and execution in India. One cannot imagine the present-day development of

54 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA

Medical Records, without the strong foundation laid by him 40 years back. Health Information Management (HIM) HIM activity focuses mainly on obtaining, analyzing in a systematic order the traditional and digital medical information for continuity of patient care and many other purposes such as medical education, research, legal and public health etc. With the widespread computerization of health records, traditional (paper-based) records are being replaced with Electronic Health Records (EHRs). The tools of health informatics and health information technology are being increasingly utilized to introduce efficiency in information management practices in the healthcare sector. Health information management professionals are specialized in this field to maintain efficiently the patient medical records and health information according to the highest standards, and protecting data integrity, the confidentiality and secure data and making available only to authorized personnel. Health Information Management (HIM) is a vital part of the healthcare delivery system that provides for the maintenance of health records in hospitals, clinics, health departments, insurance companies, governmental agencies, and many other health related settings. HIM professional’s responsibilities are becoming increasingly significant as the healthcare industry continues to transition to Electronic Health Records (EHRs). As Health Information Management professional works with hospitals and allied health institutions, insurance, clinical, financial, and software companies is responsible for the management of health information in a scientific way that is not only useful for patient, physician, hospitals, medical education and research, but also for legal, insurance, public health or national health and international health agencies. Make a Health Information Management Career a Good Choice A Health Information management professional is highly trained person, acquaints with the latest technology applications, policies and procedures affecting healthcare provider workflow. Opportunities are available to work in small medical practices and the large hospital systems with many locations. Health information management professionals perform essential operations needed to be executed in the daily healthcare provider environment. An exciting and challenging career in health information management is possible only if the individual willing to gain the specific education leading to great personal and professional rewards provided the individual committed to the profession to do his/her best. Education is crucial for HIM workforce Education is a cornerstone in supplying the healthcare system with a qualified and trained workforce to provide a quality service and, specifically for the HIM profession, to provide high-quality data. Coordination between educational institutions and practicing professionals is crucial in ensuring that education meets the market demand. In addition, modification to Education and Training Skilled Workforce Service Delivery Service Development and the creation of new materials for an HIM educational program should be based on stakeholders’ need. However, there is no clear picture, as to how many graduates are in the field working for the HIM field and how many are really satisfied with the job and how many feels that they are holding the positions that are below in terms of financial remuneration or not getting the esteem which they deserve. Therefore, it is necessary to review and possibly revise the HIM competencies by many educational institutions of different countries which offer these programs. Therefore, it is necessary to determine the qualifications framework, the allocated job titles and the key competencies. It is also important to determine the certification body for those involved in HIM before they join the workforce. The relationship between education and training in providing a qualified workforce to an organization that must deliver a service. It also clarifies that service development influences the education and training sector; therefore, educators must be involved in supporting the workforce through

55 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA

in-service training and continuing education. Due to rapid developments in the HIM profession, there are many new job titles and responsibilities for HIM professional’s due to that development, the HIMA in collaboration with the HIM educational institutions must create a career map for the HIM profession. Despite, having good career, the HIM strategic planning and workforce planning are done in certain cases without involving HIM professional’s decisions are made for creating policies and standards. Despite the importance of HIM to the healthcare system in recent years, policy makers and leaders have paid scant attention to the role of HIM professionals. Thus, there is now a specific and crucial need to raise the recognition of the HIM profession by addressing all current challenges and making plans to cope with the ones to come. This will require loyal HIM professionals to join hands in each of their contexts. In addition, HIM professionals must maintain their own strength and motivation, and that of their subordinates by joining in the national professional association and develop standards, suggest educational programs, professional abilities in effective and efficient HIM in healthcare institutions. Conduct regular workshops, conferences and continued education to uplift the professional knowledge, skills and develop positive attitude towards loyalty, commitment and performing to the utmost level of standard criterion. Medical Records in 21st Century Medical Records had developed in parallel to the Medicine and Information Technology. Several advancements and new techniques in the clinical information management besides the demanding needs of the patients, reimbursement warrants the continuous advancement in the Medical Records field. The change in the profession name from Medical Records to Health Information is one of the evidence that management of patient information changing from traditional records storage to availability of information instantly in a secured manner. Role of HIM professional in 21st Century The role of Medical Record professional is drastically changing inst 21 century, from traditional storage of medical records, getting records completed by the health care providers, preparing the statistics retrospectively is changing in a multi-dimensional way. Advancement in the healthcare, information technology and reimbursement is demanding the HIM professional’s role as developing standards in clinical documentation, perform master data management, collect and audit clinical and patient information, storing and sharing it securely, and having the system customized for the concurrent data analysis to assist the management to perform clinical and business analysis. Traditional Vs Practical Having seen the development in the Medical Records and the drastic change in the role of HIM professional to suite the present-day requirement. We need to relook at the Medical Records Educational curriculum to enrich the future generations to cope with the advancements. The author suggests that the fundamentals such as Anatomy, Physiology, and Medical Terminology are the core which cannot be ignored. In addition to the core subjects, Medical Record Management in general, must be sub-classified into specific subjects such Information Governance, Security and Confidentiality, Clinical Documentation Improvement etc.It is strongly felt that every HIM program should include Information Technology and basic of programing, this will give immense strength to the HIM professionals to interact with the EMR development team or vendors to get the appropriate EMR solution for the hospitals. The present statistics curriculum where in students are trained with the traditional formulas and practical sums to be moved into Business and Clinical Analytics where in students must be trained on analysis of data and usage of data in multi-dimensional model that will help to improve the business

56 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA and clinical performance. HIM professionals are the cog of the Health Care Delivery System, they need to interact with the top management, Medical, Nursing, Administrative and operational staff. Though everyone is completing a minimum of two languages with English Language as mandatory at school and university curriculum, most of us are not competent enough in communication skills and develop inferiority complex during our interaction with the highly skilled physician. This has been barrier to implement the medical record policies and procedure and many of us compromise our profession. The most important need and requirement for a HIM professional to be successful is to have good written and spoken communication skills. Hence, I strongly feel that Building Communication skills improvement to be one of the subjects as part of HIM Education. Last but not the least Medical Record educational institutes should collaborate with national and international institutions and participate in the exchange program by sharing the information and continuously look for curriculum review once in every 3 years. Due to rapid developments in the HIM profession, there are many new job titles and responsibilities for HIM professional’s due to that development, and AHIMA has created a career map for the HIM profession. Despite, having good career, the HIM strategic planning and workforce planning are done in certain cases without involving HIM professionals and while decisions are made for creating policies and standards, the HIM professionals are not invited to attend. Previous studies have acknowledged generally that responsibility for ensuring the sustainability and availability of the HIM workforce lies with the government, educational and training institutions, healthcare institutions and HIM professional associations. Modification of HIM traditional education In view of emerging technology and implementation of electronic health records, the conventional responsibilities of HIM department will diminish and need revision of HIM traditional educationto corporate competing syllabus to generate innovative HIM leaders on modern lines to meet thenew challenges of maintaining paperless records with huge generated data, need to bring the healthcare cost which is burning issue for all the healthcare institution across the globe. HIM professional move from conventional safe zone to threatening challenging role The hospital activities must be critically examined to ensure that the services, efforts and funds are not wasted, abused, not duplicated, unnecessarily experimented, no communication gap, expansion of departments internally or externally without justification and also to ensure judicious utilization of beds, proper distribution of manpower and resources. HIM Professionals must work with passion and dedication In view of spiraling cost and high expectation of quality of care by patients, HIM professionals must work with passion, dedication, and must widen their focus and broaden their horizons. Everyone must prove their skills and to provide vision to the organization. In view of finding the ways to contain cost without scarifying the quality of care, the hospital management needs help to address this continual problem. This is an opportunity for Health Information Managers to assume leadership roles and be part of the senior management team to support them in providing facts for business opportunities, clinical care improvement, efficient Revenue Cycle Management etc. This can lift the status of the HIM professional to a new level, with different dimensions of roles and functionalities with emergence of EMR that would play a pivotal role for planning and executing data collection and performing big data analytics, educating physicians and care providers on documentation needs and providing extensive support in revenue cycle management. This Can be achieved by having continuous audits and quality assurance programs involving all the healthcare providers. Although technology is taking over traditional methods, HI Managers must be

57 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA

vigilant with their educational background and professional expertise to prove indispensable healthcare team member. HIM’s challenges Ensuring the privacy, security and confidentiality of personal healthcare information has been a fundamental principle for the Health Information Management (HIM). Today HIM professionals continue to face the challenge of maintaining the privacy and security of patient information becomes more and more distributed in electronic systems. The challenge of this responsibility has been increased due to the constantly changing legislative and regulatory environment. HIM is an Expert Him professional is an expert who possesses comprehensive knowledge of medical, administrative, ethical and legal requirements related to healthcare delivery and privacy of protected patient information. Manages people and operational units like Release of Information, File Room, Transcription Coding and Billing etc., Participates administrative committees and prepares budgets. HIM interacts with all levels of an organization such as clinical, financial, and administrative and information systems. Conclusion The need for qualified HIM professionals is so huge, there is an acute shortage and dire need of health records/information management professionals across the country. For which adequate professionals are needed to manage HIM departments in all the health institutions. Without which, the health institutions especially, the hospitals must function without HIM departments or withnon- qualified persons to maintain highly sensitive and most vital records of patients written by highly paid and qualified healthcare providers. Through this stimulus, it is possible for all the institutions to implement the standardized electronic medical/health records and standardized HIM educational programs in all the health and educational centers. India being one of the nations with high young population with literacy of over 90% and advantage of having English language there is a bright future for talented HIM professionals in and around the world to fill the huge demand for the HIM profession. However, with the improvement of HIM educational curriculum we are broadening the horizon. References “Medical Records Organization and Management-2nd Edition; by Dr. GD Mogli, Jaypee Brothers, Medical Publishers (P) Ltd,” “Innovative HIM Education with MOC-UP Lab and Practical Training to meet the needs of Developing Countries for 21st Century” by Dr GD Mogli, published in the proceedings of 18th International Federation of Health Information Management Association (IFHIMA-2016)z” held from 12-14th October 2016, at Tokyo International Forum, Tokyo, Japan. “Physician treat Patient and HIM treat Hospital for controlling healthcare cost”by Dr. GD Mogli. published in the proceedings of 18th International Federation of Health Information Management Association (IFHIMA-2016) “ held on 12-14th October, 2016, at Tokyo International Forum, Tokyo , Japan. Roles and Challenges of the Health Information Management Educator: A National HIM Faculty SurveyShannon H Houser, PhD, MPH, RHIA, assistant professor, Linde Tesch, RHIA, education quality manager, Susan Hart-Hester, PhD, professor, and Claire Dixon-Lee, PhD, RHIA, FAHIMA, CPH, vice president for education and accreditation Health Information Management 2025: Current “Health IT Revolution” Drastically Changes HIM in The Near FutureBy Chris Dimick.

58 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA

Medical Record Department Initiative, 2016 Quality Improvement Project Title: Develop Comprehensive Medical Records Audit System Mr. KAPADIA NIPUL SHANTILAL AGM-PHARMACY & MEDICAL RECORDS APOLLO HOSPITALS INTERNATIONAL LIMITED, GANDHINAGAR, Ahmadabad, GUJARAT

Overview: Primary role Of MRD is safe guarding the records and to issue them on demand. Bridges the gap between medical and non-medical departments. Enables continuity of care to the patients without difficulty at appropriate time. Governed by the Medical Records Committee for the department to function efficiently. The medical record must be accurate, complete, and timely of course, the caregivers shall legibly write it. MRD Audit: A quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change.” We Initiate the MRD audit to improve the quality standard of medical record through PDCA cycle method, this is discussing below: Plan:

1. Unorganized process in Open Audit. 2. Lack of clarity in Open Audit report, which was maintained manually. 3. Making Report from Manual report also time consuming process, stakeholder wise, Identify the ward wise. Problem 4. Lack of goal awareness regarding Open Audit Process. (What?) 5. In Close Audit segment, storage of file completion area. 6. Software of Close Audit has many limitation, in making monthly analysis 7. Generation of Incomplete Outpatient File.

59 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA

In MRD committee meeting, members are comes under one platform discuss & verify the above problems, make root cause analysis & they find below written points: Analyze the Problem 1. Lack of support & awareness from stakeholder of Audit segment. (Why?) 2. Updated software needed for data analyze & report creation. 3. No dedicated software & checklist in various Area of OPD. DO:

1. Mapping the process flow of Audit segment 2. MRD & IT jointly moves for updating of close audit software in Hospital Information System on experimental basis.

Develop 3. Introduction of new open audit & OP audit software upon the success rate of Solutions Updated close audit software. 4. Close supervision for new audit process. 5. Creation of dedicated checklist of every audit segment. 6. Searching of new spacious Close audit area

1.Implement the new Open & close audit Process 2.Making the entry of data in Updated close audit software & maintaining audit review tool documentation in hardcopy. Implement 3.Conduct Training& Awareness program for representatives of Stakeholders Solution 4. Engineering Dept. Select a room in Silver wing of hospital building & start the modification work. 5.Implenentatin of Out Patient audit checklists in various OP area CHECK:

1. Generating Computerized close audit report successfully & Planning to introduced new Open & OPD software as earliest. Evaluate 2. More Participation of Every stake holders The Result 3. Medical Forms are in Booklet format, which make slowdown in Close Audit process. Single forms & colour coding will be more effective. 4. Some medical forms also updated which are reflected also Open & close audit checklist. Open & Op audit software also introduced & data also entered now in new software. Monthly Open & close audit compliance report stakeholder wise generating, which Achieve carries more clarity. It savings times also. the desired OP audit segment started & implemented successfully various are (General OP , Dialysis, Goals Endoscopy, Dental, Physiotherapy, Emergency) MRD committee members start medical forms in single format & make colour code also, with co coordinating Quality Department

60 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA

ACT:

1. After the analyzing compliance report, it giving clear picture of every stake holder’s compliance in close & Open audit. Corrective Action & 2. Conducting weekly training program & interactive session of staff to proper Analyze the understanding every audit segment, discussing the existing problems. difference 3. Again PDCA cycle need to be start for overcomes the existing problem & quality improvement.

All Audit Segments are discussed briefly below annexure wise. • Annexure- 1 – In patient Open Audit • Annexure- 2- In patient Close Audit • Annexure- 3 - Out Patient Close Audit Annexure- I Open Audit This audit segment associated with active ip patient file in wards, ICU & other areas of hospital. The target & goal of this approach to find out the incomplete documentation in various areas from stakeholder side. Secondly, assist in quality improvement of documentation. In initial stage, this audit data preserved by manual method, which creates lack of clarity in record completion & report creation, analysis. To overcome this problem, MRD & IT jointly move for making open Audit software in Hospital Information System. After a hard struggle, we get a positive bright light in this issue. From February onwards we are starting maintaining the data in this audit software. 1. Processes involved in the implementation of the parameter: • At morning before 10:30am. Lists of patients detail send by MRD team to all stakeholders by mail (last 24 to 48 hrs admitted patients). ↓ • By 10.30 am MRD person will kept open audit format in all respective IPD file as per published list. ↓ • Open audit team members which include Medical officer, Nurse, Physiotherapist, Operation, Dietician, MSW will do an audit of file document completion compliance and intimate same to respective area stakeholder if not completed. ↓ • At the time of audit, cross area audit system will be adopted e.g. if person working in standard ward will do a file audit of semiprivate ward as per JCI guideline. ↓ • Next day morning 9.30 am. Onward MRD person will remove a completed audit paper form & update the audit report in HIS & sent to all stakeholders by email every day.

61 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA

2. What difficulties did you face and how were they overcome: I. Designing the process flow was the first demanding task. It was collaborative effort allof departments (Medical services, Nursing, MSW, Dietician, Physiotherapy, Operation & Pharmacy). This was done failure mode effect Analysis (FMEA). II. Compliance to process flow was second Challenge. It was ensured by entering data Open Audit Software in HIS & maintaining accountability through documentation in audit review tool. III. Training of staff for proper understanding the auditing method.

Screen Shot of updated Open Audit Software:

3. What are the existing problems? 100% compliance is difficult to achieve, but there is always scope for improvement. Surgeon, medical officers & nursing team especially surgical cases, they have to improve lot. Staff Motivation is also required time to time to withstand the initiative. Changing the work culture & building awareness for this audit is a continuous demanding process. 4. Future plans to overcome the existing problem: Ensuring more active participation of Medical officers, Surgeons & nursing team especially surgical cases. Also focusing limelight on some forms i.e. Surgery consent, Operation Note & post operative instruction from both side surgeon & anesthetist which is essential for International patient safety goal in journey of JCI accreditation. Annexure- II Close Audit This audit segment associated with all discharged ip patient files of hospital. The target & goal of this approach to find out the incomplete documentation in various areas from stakeholder side. Secondly, assist in quality improvement of documentation. In initial stage, this audit data preserved in Close audit software, but due to many limitations in software, we facing problem in creating monthly analysis. To resolve this issue, as per demand of MRD, IT makes necessary updates in software. Secondly, due to space problem in file completion area, facing difficulties to accumulate all stakeholders at a time. As per our demand, engineering dept. makes deep concern regarding this & after overcome few hurdles they provide a new spacious file completion area. Its makes more hassle free the whole process.

62 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA

1. Processes involved in the implementation of the parameter: • Every day by 3pm one operation personnel will handover complete file (Including all investigation report) to MRD staff in MRD close audit room in Silver wing 2nd floor. ↓ • MRD staff will receive the file along with receiving folder. ↓ • All stakeholders (Medical Officer, Nurse, Medical social Worker, Dietician, Physiotherapy, and Pharmacy) should sit alternatively with adequate time everyday in audit room & complete the file along with Close Audit form within 48hrs after discharge. ↓ • MRD staff will collect the close audit form all stakeholders after the completion with sign & date& enter the data in to HIS. ↓ • Then file will be shifted in a main MRD Storage Area. 2. What difficulties did you face and how were they overcome: I. Designing the process flow was the first demanding task. It was collaborative effort ofall departments (Medical services, Nursing, MSW, Dietician, Physiotherapy, Operation & Pharmacy). This was done failure mode effect Analysis (FMEA). II. Compliance to process flow was second Challenge. It was ensured by creating Open Audit Software in HIS & maintaining accountability through documentation in audit review tool. III. Training of staff for proper understanding the auditing method. IV. Reports were missing (Such as- Echo, Laboratory Investigation reports) come in some IP files, it resolves by close supervision at the time of file receiving. V. After introducing of new forms in booklet format, the close audit process were getting slowdown step by step. Quality dept. bring into limelight to resolve this problem, & change those forms into single format from booklet. Vi. To make the process fast, quality dept. make color coding all forms stakeholder wise for easy tacking of forms, & this initiative really works, also speed up the process. Screen Shot of updated Closed Audit Software:

63 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA

3. What are the existing problems? Though 100% compliance is the benchmark of this audit, but some silly mistakes decrease the compliance rate. Every stake holders have lots of scope to improve their area & give full outcome in this initiative. 4. Future plans to overcome the existing problem: This audit approach improving step by step & it should be undergone through continuous quality improvement by reducing silly mistakes, which helped us to make a significant impact on performance of MRD & in contributing towards JCI accreditation. Annexure- III OP Close Audit 1. Processes involved in the implementation of the parameter: This audit approach divided in to various angle. i.e. General OPD audit, Dental audit, Emergency File audit, Dialysis audit, Physiotherapy Audit, Chemotherapy & Radiation therapy audit. Those audit segments are done specified audit checklist, which aredisplaying below & after that those data collected from checklist entered into dedicated software in HIS, which is launched in After February’16. 2. What difficulties did you face and how were they overcome: I. Designing the process flow was the first demanding task. It was collaborative effort variousof departments (Medical services, Nursing & Reception) from all corners of OPD.This was done failure mode effect Analysis (FMEA). II. Designing of Various OPD checklist according to their specified forms was the most challenging job. III. Measuring the outcome of this initiative was further Anxiety. It was overcome by monitoring the audit process & it’s Streamlining. The data was available monthly for analyzing the reasons for non compliance. 3. What are the existing problems? Firstly, Though 100% compliance is the benchmark of this audit, but some silly mistakes decrease the compliance rate. Secondly, timelessness of OP files submitting to MRD also existing headache. 4. Future plans to overcome the existing problem: This is a continuous quality improvement approach. Increase supervision from both OPD & MRD side & conducting awareness training session on timelessness of OP files submitting to MRD. Screen Shots of New OP Audit Software:

64 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA

The introduced Checklists are displaying below:

Apollo Hospitals, Ahmadabad

Emergency Close Audit Medical Record Review Tool Stakeholder FORMS NAME YES NO N/A Remark Reception REG. FORM & CONSENT

Initial Assessment DOCTOR OP Discharge Advice Patient family Education Emergency Nursing Chart Morse fall Risk Assessment Nursing Patient family Education Nurse hand Off Communication Any Reports AUDITOR:

MEDICAL:

NURSING: MRD:

RECEPTION: AH/MRD/014/V1

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Apollo Hospitals, Ahmadabad

Endoscopy Close Audit Medical Record Review Tool

Stakeholder FORMS NAME YES NO N/A Remark

Reception REG. FORM & CONSENT

Short History & physical

Examination Sheet Sedation Assessment

Procedural Record DOCTOR Pre Discharge Assessment

Procedure Consent

Consent For Anesthesia

Nursing Assessment

Morse fall Risk Assessment

Patient family Education Nursing Intra Procedural Record

Post Procedure Monitoring

Endoscopy Report AUDITOR: MEDICAL:

NURSING: MRD:

RECEPTION: AH/MRD/015/V1

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Apollo Hospitals, Ahmadabad

Dialysis Close Audit Medical Record Review Tool

Stakeholder FORMS NAME YES NO N/A(( Remarks Reception REG. FORM & CONSENT Consent For Dialysis Short History & physical

Examination Sheet Medical Reconciliation Pre - Dialysis Medical Assessment & Hemodialysis DOCTOR Record Critical Value Reporting Ongoing Therapy Post Dialysis Assessment Patient& family Education Current Summary Nutritional Assessment Dietician Patient& family Education Dialysis Notes Pre - Dialysis Nursing

Assessment Morse fall Risk Assessment

Critical Value Reporting Patient& family Education Equipment Checklist Any reports AUDITOR: MEDICAL: DIETICIAN: NURSING: MRD: RECEPTION: AH/MRD/016/V1

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Apollo Hospitals, Ahmadabad

Dental close Audit Medical Record Review Tool Stakeholder FORMS NAME YES NO N/A Remark

Reception REG. FORM & CONSENT

Dental Record

Procedure Consent

Doctor Time out OUT PATIENT RECORD Current Summary

NURSING ASSESMENT NURSING: Any reports

AUDITOR: MEDICAL: NURSING: MRD: RECEPTION:

AH/MRD/017/V1

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Apollo Hospitals, Ahmadabad

Physiotherapy close Audit Medical Record Review Tool

Stakeholder FORMS NAME YES NO N/A Remark

Reception REG. FORM & CONSENT

Physiotherapy Consent

Physiotherapy Assessment Doctor Record

Rehabilitation Outpatient

Record

Nursing: OP nursing Assessments

AUDITOR:

MEDICAL:

RECEPTION: MRD:

NURSING:

AH/MRD/018/V1

MEDICAL RECORDS DEPARTMENT OUT PATIENT FILE AUDIT CHECK LIST DATE:

DATE REG. FORM NURSING OUT PATIENT CURRENT PATIENT’s DOCTOR UHID OF SPECIALITY & CONSENT ASSESMENT RECORD SUMMARY NAME NAME

REG. REMARKS Y N Y N Y N Y N N/A

AH/MRD/007/V1

69 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA Birth to Death – Need of eHR for Population Health Surveillance System

Mr. Vijaykumar.A M.Sc Medical Informatics, DMRT, CMRA Head - Medical Informatics Indraprastha Apollo Hospital, New Delhi - 110076. Mobile: 8050273352, Office: 01129871958 Email: [email protected] INTRODUCTION: Health care in developing countries should commit to use innovative, data driven methods to improve the health of population. eHR are an emerging technology for managing patient care, in fact it has become one of the new buzz words in today’s healthcare. Need of Population based health surveillance system from Birth to Death is potential to enhance general health surveillance by providing information on the prevalence, treatment, and control of health conditions that are typically managed in a patient care setting. OBJECTIVE: Overall objective of the eHR for population Health Surveillance System is integration & modernisation of the Information Technology infrastructure for health system for collecting, compiling & analysing information of individuals from birth to death data from clinical aspect. Purpose of eHR for population Health surveillance is to create and upgrade the content & accessibility of basis public services in health care system to elaborate several new e – health services. METHODOLOGY: Developing eHR for population Health surveillance system should be incorporated and developed based on the following - STANDARDS: Different health care practices often use different proprietary electronic health record application platforms and each application platform has its own standards and conventions. One of the key challenges to combining data from multiple electronic health record into one surveillance system is semantic equivalency across platforms and even across contributors using the same platform. That is a data element must have the same meaning for each health care practice entering that element. DATA QUALITY: The usefulness of eHR population Health surveillance system is depends on the timeliness, accuracy, completeness and comprehensiveness of the data. Ensuring uniformly high quality is particularly challenging, data entry will be decentralized and dependent on the care and effort of individual providers. To maximize completeness and comprehensiveness developers should focus on indicators of population health that are found in structured rather than free text fields and that are consistent with areas targeted by meaningful use. DATA STRUCTURE & SYSTEM DESIGN: The first considerations in developing effective eHR is the structure of the dataset. If her developers can choose between aggregate and line level data they must consider the benefits and costs of each approach. Using aggregate data may alleviate some of these resource and confidentiality concerns.

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CONFIDENTIALITY: Concern for patient confidentiality is paramount in all surveillance systems, and incorporation of established secure technology through the data sharing process is critical. By using a distributed model and exchanging only aggregate data health departments obtain population health information and health care providers retain control of individual patient information in accordance with the accepted standards worldwide in healthcare. SELECTION OF POPULATION HEALTH INDICATORS: The selection of indicators depends upon the purposes of the system. Indicator domains could include estimates of disease incidence, disease or risk factor prevalence, disease control, receipt of recommended services or care seeking behaviour. SELECTION BIAS & NORMALISATION OF OUTPUT: Selection bias presents a challenge to the interpretation of eHR for health surveillance data. eHR data are only available for individuals who seek health care. Those who seek health care most frequently and thus have the most complete records may be more likely to have underlying health conditions that require regular monitoring. DUPLICATE RECORDS: Duplicate records can threaten the validity of estimates derived from a Population Health Surveillance System. Using line level data with unique patient identifiers, duplication is not a major threat. But in surveillance systems where data are collected in aggregate one patient who visits two participating practices will be counted twice, also information may be split across the patients records inthetwo practices resulting in what appears to be two patients each receiving suboptimal care. While duplication cannot be avoided in an eHR based on aggregate data, it can be minimized by narrowly limiting the type’s providers who contribute data. INCLUSION & EXCLUSION CRITERIA: Aggregating data across all practices in a health care practice will not be sufficient to develop a valid surveillance system. Depending on the population health indicators of interest different types of contributing practices should be included. INNOVATIVE ELEMENTS & NOVEL APPROACHES TO IMPLEMENTATION: In terms of the system architecture, eHR is a complex information technology & communication innovation. The main novel principles of the system are its service oriented structure, standard communication method with external information systems via a common message centre, autonomy of services and its scalability. Implementation of these principles is important, not only for technical performance and security of eHR system. CONCLUSION: Clearly, the Need of eHR for Population Health Surveillance System implementation is rely upon the driving forces of our society that will bring the transparency in health care by using standard practice tool available worldwide. In future public, private organization should adopt and implement standard eHR population health surveillance system to remain viable in a highly qualitative healthcare system. eHR for Health surveillance system should plan for future regulatory standards accepted worldwide. Additionally, the public authority in the country should address the demands that concerned authority make for specific information that must be collected in individual and aggregate form. Data capture, storage, manipulation, and retrieval be the cornerstone of the future.

71 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA Pace of Him Through Healthcare It.. NageswaraRao Karri MBA (HM) Manager – HIM Aayush NRI LEPL Healthcare Pvt Ltd. Vijayawada, Capital Region of Amaravati, AP [email protected]

Today’s HIM professional is the critical link between care providers, patients, insurance companies and government health authorities. Success in this position starts with a comprehensive knowledge of medical, administrative, technical, ethical and legal requirements and standards related to healthcare delivery and the privacy of protected patient information. With the ever-increasing pace of health care regulatory change that includes the ever challenging adoption of latest Healthcare IT tools become critical in ensuring the right information to make the correct decisions. The latest Healthcare IT tools brings immediate access to advanced, up-to-date primary source content and expert tools to ensure proper clinical and administrative documentation, while it allows us to have quick, easy access to the comprehensive information and tools that are necessary for effective Health Information Management. Each part of the HIM professional’s role in managing patient health information and medical records, including administering computer information systems and collecting and analyzing patient data, can strongly impact organizational risk. So, we need solutions to proactively manage riskand compliance-related workflows, including the ability to track quality checks, manage documents and policies, disseminate training and communication, and even be automatically informed of changes to the legislation that impact you directly. The health information technology revolution has begun, and as it progresses, the shake-up in health information management departments will leave the profession profoundly different.In record time and at an unprecedented pace, the electronic health record (EHR) has spurred a revolutionary change in HIM that’s modifying the profession as each day passes. Health Information Technology (HIT) Health Information Technology is revolutionizing our life, our ways to interact with each other, and day-to-day life and work. Its application in healthcare includes electronic health records, telemedicine, and health information systems with decision support, mobile health and eLearning tools. Embrace the revolution Even with HIT (Health Information Technology) revolution it cannot replace HIM fundamentals. Policy surrounding health IT has also yet to be burned onto the healthcare industry’s hard drive. HIM experts should pick up the mouse and help to design the policy of HIT. HIM Sectors racing with Healthcare IT 1. Electronic Health Records (EHR) An Electronic Health Record (EHR), or electronic medical record (EMR), is the systematized collection of patient and population electronically-stored health information in a digital format. These records can be shared across different health care settings.

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2. Clinical Documentation Improvement (CDI) • Clinical documentation is at the core of every patient encounter, in order to be meaningful it must be accurate, timely, and reflect the scope of services provided. • Successful CDI programs facilitate the accurate representation of a patient’s clinical status that translates into coded data. 3. Coding & Billing Services ICD-10-CM is effective from 1-Oct-2016 to 30-Sep-2017 and clinical terminology systems such as SNOMED CT developed by International Health Terminology Standards Development Organization (IHTSDO). ICD-11 is under beta draft version only. 4. ROHINI (Registry of Hospitals in Network of Insurance) ROHINI (Registry of Hospitals in Network of Insurance) is a registry of unique hospitals in the Health Insurers and Third Party Administrators (TPAs) network, in India. The registry has been developed by the Insurance Information Bureau of India (IIB) promoted by Insurance Regulatory Development Authority of India (IRDAI). The list now consists of approximately 33,000 unique hospitals. 5. Medical Transcription Many newer versions of software are using for a high quality transcribed health information files through online and offline. Speech Recognition Medical Transcription Software really changed the pace of healthcare with faster transcription speed and quality of health information. 6. Privacy & Security Successful privacy, security, and confidentiality programs depend on HIM professionals for their expertise on the applicable laws and regulations impacting the appropriate management of healthcare data available to the right people at the right time. Digital signatures are to be used to prevent non-repudiation (establishing authenticity of author of the document) and trust by the recipient. 7. Release of Information The release of patient health information has remained a critical and important task of the HIM profession. So, healthcare facilities are trying to capture all the requests made by the patients, insurance organizations, doctors, and other paramedical staff in digital way for all future instant references. 8. Tele Medicine: Any Time – Any where Telemedicine is the use of telecommunication and informationtechnology to provide clinical health care from a distance. It is also used to save lives in critical care and emergency situations. Telemedicine including telenursing, telepharmacy, telerehabilitation, teletrauma care, telecardiology, telepsychiatry, teleradiology, telepathology etc.

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9. Quality of Healthcare Achieving high quality, cost-efficient healthcare requires collaboration among all healthcare professionals and stakeholders. Drug safety, medical mistakes, healthcare-acquired conditions, information system constraints, and fragmented delivery systems are just some of the many issues affecting healthcare quality and safety. There are many advanced softwares which are capturing all real time indicators related tothe patient care to enhance the quality of care given in a particular time. 10. Information & Data Analytics Informatics and data analytics are crucial operations for healthcare organizations. Healthcare Professionals are required to acquire, manage, analyze, interpret, and transform data into accurate and consistent information in a timely manner. 11. Aadhar – an Unique Identification Number Integration and authentication with Aadhar unique number shall make health information management simpler as it is meant to be a convenient system to prove one’s identity without having to provide identity proof documents whenever a resident seeks any type of medical service across India. 12. Registry Services (Medico-Legal cases, Births & Deaths, Disease surveillance & Cancer etc.) Registry service is the process of keeping a database on patients who share a particular characteristic such as online births & deaths, notifiable disease surveillance, tuberculosis and cancer registry etc. The data is then used to assess the quality of care, disease statistics, monitor trends, and do prevention and research. Conclusions & Recommendations: HIM professionals need to capture valid and reliable data that can be transformed into useable information to aid in developing change strategies with HIT. HIM professionals possess unique knowledge and expertise to enable strong partnerships with clinical and executive teams to advance the quality and safety of patient care delivery. HIM professionals are playing key role in the delivery of safe, high-quality patient care with advanced real time data capturing tools and digitalization of patient clinical charting software with advanced healthcare IT.

ONE PATIENT..ONE RECORD.. ONE NUMBER ACROSS INDIA

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“From Paediatric Age to Geriatric Age a New Health Information Management System in 21St Century” Md. Zakir Hussain Joint Secretary - HIMA Sr. Manager Medical Records Basavatarakam Indo American Cancer Hospital and Research Institute HYDERABAD

About Us: Our Institute Basavatarakam Indo American Cancer Hospital & Research Institute started about 17-years back. It is a Super specialty in Cancer care with 530 beds which include 50 beds state of the art International wing exclusively dedicated for Overseas Patients. Our Hospital is accredited with prestigious NABH, NABL & TUV (OHSAS) and ranked the only best hospital in Telangana & Andhra Pradesh amongst 15 cancer hospitals in India- a survey conducted by The WEEK-Nielsen Magazine. And also our Institute is widely known across the country as a premium cancer treatment and education centre. CNBC – TV18 and ICICI Lombard jointly rated BIACH & RI as the best single specialty in oncology in India during 2014-15. We are committed to Mission Provide quality cancer treatment at affordable cost. Vision To develop BIACH & RI as a premier institution for cancer prevention, treatment, education and research in the country in next 5 years PREAMBLE: We are in modern period of Internet i.e. 21st Century. The Internet is a global network connecting millions of computers. More than 190 countries are linked into exchanges of data. We require a new global network Health Information Management System from pediatric age to geriatric age. In this current global computer network age, every Patient and Patient attendants not only like to have better Quality of the Health but they want to use standardized communication protocol provided by the hospital. Hospital need to provide Quality Health Care and communication facilities to the Patients satisfaction.

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High quality Medical care requires maintaining comprehensive and accurate medical records System. Medical Records is the backbone of any medical institution. The advancements of Health information Technology (HIT) is revolutionizing our life and Medical records maintenance has become easier and more efficient. All the physical forms must be replaced with computer screens and data can captured directly. It is a revolutionary change in Health Information Management in this modern trend. WHAT IS MEAN BY HEALTH INFORMATION/MEDICAL RECORD? Health Information or Medical Record is the legal patient information i.e captured in standardized format in Hospitals and ambulatory situations. Medical Record may include demographic details, Chief complaints, History of presenting illness, History of past illness & treatment, Allergies & Medications, Family History, personal history, Clinical Nutritional status, Laboratory test results, Radiology images, Vital signs, Diagnosis and present plan of care and treatment etc. WHAT IS MEAN BY ELECTRONIC HEALTH INFORMATION/ELECTRONIC MEDICAL RECORD? The above patient information’s which were created in digital format is defined as Electronic Health Information or Electronic Medical Record System. It is an information sharing system for both patients and Doctors. The doctors add their data, prescriptions and results etc. in to this web based file, the patients and other doctors can access from anywhere in the world. Hence the EMR is a digital version of a chart with patient information stored in a computer. It provides critical data that informs clinical decisions, and they help coordinate care between all providers in the healthcare ecosystem. ELECTRONIC MEDICAL RECORDS DESCRIPTION: Medical Services delivered to patients will be more competent and effective since doctors will be able to obtain operational information about to patient’s medical condition. Data exchange of Health Information from birth to death for every human being through worldwide with universal identification. It provides accurate medical statistics enabling better and more efficient health care planning, organization and financing. To ensure effective patient management with quality improvement. Patients to access their medical data irrespective of time and place. To ensure patients and medical staff that all personal data will be stored and managed properly and safely. To assure personal data protection and patients rights according to the laws. EMR System is most important for the Patient Care, Legal Affairs, Quality Review, Privacy, Security, Confidentiality, Education, Research, Public Health and Insurance. BENEFITS OF EMR: Online availability of records for Doctors Rapid storing of available information of a patient

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Quickly retrieve the concerned information of a patient Standardization of Diagnosis International Coding of procedures Timely and accurate health Data Validation Checks and Security Procedures Saves time & space Improve patient safety Avoid poor penman ship errors Elimination of duplication Automatic reminders and clinical decision support Decrease cost in long run Disaster recovery INSTANT ANY TIME & ANY WHERE ACCESS: Instant any time-anywhere access to one’s medical history This is a great asset, it is an optometrists who need to travelled around the world Helps faster, error-free clinical communication between care takers Tele–medicine made easy and practical Helps seek specialist’s advice remotely-saving money &time PAPERLESS MEDICAL RECORDS: It is the potential of Electronic Medical Record to provide large scale improvements Paperless Medical Record is secure, dust-free, user friendly and cost effectiveness of healthcare Avoiding retrieval and error prone paper work Facilitating quick and accurate access Assists doctors in diagnosis and treatment Gives overall competitive edge to the hospital Monitored vital health data on finger tips Improve quality of healthcare audit and research A lot of replication which exists in any manual records. We must make every effort to capture maximum information directly into the computer. FACTORS OF EMR SYSTEM: Provide secure, reliable and real-time access to patient health information, where and when it is needed to support care. Data can captures at the point of care Integrates data from various departments like Radiology, Laboratory and any other Clinical specialized units. Support Caregiver decision making.

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Assist with planning and delivering evidence-based care to individuals and groups of patients. Support continuous quality improvement, utilization review, risk management and performance management. Support clinical research, public health, Education and health agencies. Work and provide better and faster service to the hospital and society at large DRAWBACKS IN EMR SYSTEM: Patient privacy is a major issue for today’s healthcare providers. The possible incompatibility of computer system among various health care providers can lead to difficulty in sharing the data. Safeguarding the confidentiality, integrity, and availability of patient information is no longer a goal – it is a legal requirement... Breach of patient privacy and confidentiality as flow of information is very crucial in Electronic Medical Record. Theft, sniffing, brute force attacks, concurrent usage, intentional sharing to thwart technical controls. Computer crashes makes records inaccessible. The cost of implementing and electronic records can be expensive. SECURITY MEASURES IN EMR SYSTEM: Security- the mechanism Develop action plan for addressing threats and vulnerabilities. Conduct security and risk analysis. Protect against both cyber and physical threats Protect Hardware & Software by Building alarm system Locked offices to protect Portable devices Use Authentication, Authorization & Accountability Methods Password protection measures A Security Plan addresses safeguards against tampering and theft Background checks like Contingencies in place to recover or restore lost data in case of a disaster or tragedy Administrative Safeguard: Conduct audit trials for safeguarding data An audit trials provides critical clues It tracks user actions to discourage hacking and other fraudulent activity Audit trail should track all attempts to access patient data by recording that answers to the following questions What data was accessed? When was it accessed?

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Who accessed it? Where was it accessed from? Access To Real Time Expertise Ensure that any potential technology partner has specialized & trained staff in online security measures. Designated security officer Work force training and oversight Technical Safeguards: Control an access to EMR and Secure passwords Use of audit logs to monitor users and other EMR activities and blocking the data whenever required Measures that keep electronic patient data from improper changes and Virus checks Secure authorized electronic exchanges of patient information and Data encryption THERE IS A PROSPECT: Continuous Education & Training for employees in Hospital level and also from Government level. Privacy, confidentiality and Security training is the major key for every employee Digital awareness must be continuous process Improve the security resources Biometric authentication can be considered Audit users for authorized use of EMR and develop Informatics Risk Management Committee. The Health Ministry of India recently plans to bring out a Law to protect Health Data and Medical Information to safeguard patients’ privacy, confidentiality and for standardization of e-health system. Similarly the National release center (NRC) is organizing an interactive workshops, which aims to promote of SNOMED CT in health care and introducing a uniform system for EMR and shaping a e –health future of India. CONCLUSION & OPINION: The effective Electronic Health Information Management service has been achieved by using the highest possible security level for storing the health record in the nationwide. Our study observed that most of the computeriza­tion hospitals are in the areas of billing and administration, and we feel that priority investments need to be made in the areas of Health care delivery. Government to lead the way: The governmen­ t of India should ensure adequate involve­ment, investment and completion of the IT implementation in healthcare projects. Promoting uniformity and interoperability across the healthcare system. We have sophisticated Technology for MRD in our Hospital. We have implemented EHR in our Hospital which has improved quality of care delivered to the patients and improved Hospital productivity and is helping with the ongoing research projects and publication of scientific papers – Bar Coding system for easy tracking and movements of case records.

79 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA Personal Health Record (PHR) linking with EHR gets lifelong Health Information

Dr. G D Mogli, PhD, MBA, FHRIM (UK) FAHIMA (USA) Visiting Professor of Medical Informatics, MGIM Sciences, Maharashtra Ex WHO Consultant and Sr. Consultant (eHealth Management) HEARTCOM (USA) Sr. Consultant Adviser to the Ministries of Health; India, Afghanistan, Iran, Kuwait, Saudi Arabia, Oman, Bahrain, Qatar and UAE [email protected] www.drmogli.com

Introduction: The last century has seen the growth of medical records due to its important role, initially outpatient chit (card) kept by patient was used in many clinics, physician’s offices, due to compulsion and need improved to departmental records for specialty services and ultimately found the comprehensive unit record system. The unit record system concept is that the patient and not the disease episode is the unit for health record compilation, and that each patient should have only one case record folder into which all documents related to past and present medical care are placed. However, in the manual record system, the patient information is incomplete and scattered in different health organizations because of patient extensive movement, but even, within one health institution, when patient visits different clinics or specialties, the information is disintegrated. This system served almost latter half of the 20th century and with the advent of information technology (IT), the electronic medical record with different terminology moved forward ultimately called as electronic health record (EHR) of the future. Record of the Future: Prediction indicate that eventually everyone will possess computerized health record continuing complete outpatient and inpatient data from birth to death (womb to tomb). Information gathered from various providers would be kept together as a single unit in a central data bank accessible from numerous sites. The Electronic Health Record can be part of Personal Health Record Systems. Evidence suggests that an integrated health record would be a great benefit to improving patient quality of care, it is greatest potential, unless it accompanied by lifelong personal health record (PHR). PHR to be recognized as central element of an integrated national health information system. Patient Access to the EHR: Majority people surveyed believed that having access to theirEHR would help them improve their healthcare decision making process. Clinicians preferred online patient care tools, including increased efficiency, improved patient –provider relationship, and enhanced care. Some preferred the provider office as the organization responsible for hosting the PHR. 2. Materials and Methods: The study design includes examination of different medical record system practiced in thelast century that will enlighten as to what type of medical records systems are required for the 21st century and beyond so that everyone of this globe will get swift, safe and good quality care with affordable cost. The healthcare delivery system and health records which are reflection of care provided, need to be thoroughly examined to find right solution to the problem. About to methods used to understand the hypothesis, the past and present medical practice and medical record systems to be evaluated to have clear picture and the need for PHR would be decided. 2.1. Electronic health record (EHR) an EHR refers to an individual patient’s longitudinal medical record in digital format. Electronic health record systems co-ordinate the storage and retrieval of individual records with the aid of computers. EHRs are usually accessed on a computer, often over a network. It

80 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA may be made up of electronic medical records (EMRs) from many locations and/or sources. A variety of types of healthcare-related information may be stored and accessed in this way. EHR systems can reduce medical errors, increase physician efficiency and reduce costs, as well as promote standardization of care. The EHR is far superior to all the above systems, and has remarkable benefits in implementing the system. The greatest advantage of this system is a comprehensive record is instantly accessible to all the authorized care providers from different stations, all related documents, for example; lab, radiological images, and other investigations, medication can be seen on online. Information is secured and portable through internet and web-based. 3. Results: Having learned various systems that are being practiced earlier in the 20th century and now indicate, in over a period, there has been great transformation in the improvement of patient record system due to dire need. The EHR is gradually revolutionizing the healthcare delivery system. Once, all nations will implement standardized interoperable electronic system that would be greatest accomplishment for all the population of the globe. 3. Discussion and Conclusion: 3.1. Problems of EHR implementation: Despite the fact, the EHR has proved to be a great potential and the “record” of future, also has some implementation difficulties, due to different vendors developing software’s tailor made or in-house made to suit certain health institutions, is not helping in exchange of information. This is also a hurdle and being tackled by applying various international standards like HL7, SNOMED-CT, LOINC, ICD, DIOCOM, NCPDP etc., to be fully interoperable. Majority people surveyed believed that having access to their EHR would help them improve their healthcare decision making process. The respondent preferred the Internet overall as the mediums for their record, but preference varied with age, with older respondents preferring paper over the Internet. Clinicians preferred online patient care tools, including increased efficiency, improved patient–provider relationship, and enhanced care. Some preferred the provider office as the organization responsible for hosting the PHR. 3.2. Purposes of PHR: Maintaining one’s own personal health record is one of the best ways to have constant access to his/her health information over the course of lifetime. Whether one changes physicians or physician relocates or retire, by keeping own personal health record, the person and his family will have vital information at their disposal at any time whether they stay or travel. With this information one can provide information to new caregivers, and discuss easily all aspects one’s health problems. 3.3. Physician office records or hospital outpatient or inpatient records: Is mostly physician oriented, or hospital oriented because they are interested mostly in their work, administrative, legal and financial concern, while; EHR and PHR would be more patient/ personal health oriented, hence enormously important to note. The PHR will have complete integrated story related to lifelong health related information that no other person or institution or organization can have. This will encompass; personally recommended care, (self-care /treatment) such as; certain symptoms have occurred and some sort of treatment or medication taken, or applied some ointment, taken some liquid diet with mixture of medicinal value food, during stay at his own place, or on visit to different places, visit to Ops, GPs, hospitals, etc. This record will act as Gap filling document between healthcare institutions and self- medicated/treatment care. Individual continued information related every day’s habits, problems, actions, troubles or sufferings etc. are recorded. This may relate to any of the systems, such as nervous, sense organs, digestive, respiratory, cardiothoracic, urinary, reproductive etc. Human body pictures with different organs (Figure 1), general common problems (Figure 2) with date occurred and duration will help the health trends of individual his/her susceptibility to certain habits, or places, or activities, etc. It

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could be seasonal, or work-related or any other issue. However, all this will add to the comprehensive information to understand health trends. This will have significant role in providing excellent data for research and will help in taking preventive measures for travel, food, work and other activities etc. There is dire need to find a solution that can improve to provide overwhelmingly and comprehensively, the entire information on health events of a patient that would help care provider to come to quick decision to provide safe care as a follow-up or continuity of care, without wasting time, duplicating efforts, and resources. The best document would be Personal Health Record (PHR).

3.4. The Definition of PHR: The “PHR is a Health Passbook containing the identification data of a person, is a lifelong electronic, universally available document, initiated at the time of birth, containing, mother’s delivery information including congenital anomaly, immunizations given. This health passbook will have briefly entire information such as episodic, hospitalization, self-medications and other habits including significant events, advance directives of living wills, organ donor authorization, usually not available to care providers. The PHR is maintained by parents/guardian till the child become responsible, followed by child development information including, immunizations, growth charts, significant events and health status. The PHR which comes from healthcare providers and individuals is a resource of health information to make health decisions. Individuals own and manage the information and maintained in a secure and private environment, with the individual determining rights of access”. 3.5. Starting of PHR: Those born prior to implementing PHR, they will need to request a copy of their current health record from all their healthcare providers, including eye doctor, dentist, and any other specialist they have seen. Contact their doctor’s office or the health information management or medical records staff at the facility where they received treatment and ask for an “authorization for the release of information” form. At least, past operative reports, discharge summaries, and significant tests from any hospital visit could be collected and placed in PHR. The PHR is a simple health passbook can be maintained on your home computer or through a reputable Web site. When traveling, you can carry a pen-drive, external hard drives or any other portable device (Figure-3) with significant illnesses, investigation reports, surgeries, allergies, immunizations, medications and other necessary emergency medical information for those individuals with special medical conditions such as diabetes, hypertension, or heart conditions should consider wearing an alerting device to inform others of their condition in an emergency. If your healthcare provider maintains a Web site where you can maintain your own health records, follow their instruction. Review the notice of privacy practices provided to you by your healthcare provider.

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3.6. How PHR can be implemented? In fact, PHR is an extension of EHR, as we have observed that medical records whether manual or electronic are being maintained mostly by healthcare providers and organizations exception to this, child health and maternal and chronic disease records are allowed to be carried by patients. This has necessitated that health records maintained by healthcare organizations may not fulfill comprehensively when needed, especially in case of emergency. Besides, this, persons suffering from minor ailments, doesn’t visit, hospitals, and applies self-medication, self-care/treatment. At times, he might take care in other than allopathic institutions; such as; Ayurveda, Yoga, Unani, Siddha, Homeopathic, herbal, etc. The EHR is practically maintained by the health organization for the care of patients, administrative, legal, medical education and research purposes, however, when patient gets treatment, the information has to be shared with PHR. Similarly, when patient was rendered care in different organizations that has to update with the current one. The PHR passbook should have the following formats: Patient Identification Data, Health Summary, Child Development, Immunizations, Selfcare/ treatments, Medications, Investigations, Hospitalization, Obstetrics & Gynecology, Therapy, Chronic Disease (old age), Dental. Patient ID format: contains three parts; part I contains: personal data, name, age (dateof birth),gender, social security number, birth identification marks, address, emergency contact address, address of insurance, part II contains; allergies, blood group; significant health problems, Part III; contain, other habits such as food, alcoholic, smoking, any addiction, environmental, exercise, etc.

Patient Care Summary: This is a comprehensive format, provision for recording chronological data such as: whenever, any health problems occur, patient should record appropriate columns. If he attended outpatient clinic, starting and ending date of episode, name of the service, problem, investigations, medications, results. Similarly, if visit to emergency room, the date visited, if hospitalization, dateof admission and discharge, length of stay, diagnosis for which admitted, If, without visiting the physician or clinic or hospital, self-medication or self-recommended treatment, also to be recorded in the appropriate format. This record is basically a duplicate record for the care received in the physician’s office or OP clinic, or ER of hospitalization. The health institutions will be maintaining the record as usual for care, administrative, legal and other purpose. However, there will be a note in the PHR, date of admission, date

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of discharge, name of institution and contact address, in case of emergency, the information could easily accessible. Similarly, other information could also be accessible. Physician’s office and OP clinic data is already available in the PHR. Patient, at times visit other than allopathic, for treatment, such as herbal, homeopathic, Unani, or Ayurveda such information is also noted in the summary sheet

Child Development: This is a growth chart including weight and height, this document is for children from 0-5 or 0-14 years, all childhood problems and other well baby clinic activities are recorded. Any significant information such as child psychology information noted at that age is also recorded.

Immunizations: This document is mainly for children and can be used for adults. This will indicate the due dates for other immunizations e.g. 1st dose, 2nd dose or 3rd dose etc.

Self-care for medication / treatment: This record is unique, because this information is available only with the PHR and not found in the allopathic healthcare organizations.

Medications: This will give chronological account of medications used, and high light on current medications used. E-prescription, refills, and address of the pharmacies

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Investigations: Chronological account of investigations carried out will be available. With the facility to have cumulative picture of different tests with dates will give the comparison that will greatly facilitate the care giver.

Hospitalization record: will give chronological account of all admissions and discharges with the results. There would be a hyperlink with that, currently treating physician or institution, if desires can access for reference.

Obstetrics and Gynecology: This document for women patients from child bearing age onwards, all visit account is recorded including any hospitalization will also appear in this format. Mammography periodic check information is also recorded.

Therapy: Different types of therapies, such as physical, occupational, speech, optometric refractions, radio therapy etc. are recorded.

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Chronic Disease Record: This record will indicate, a person suffering from any chronic disease for example, diabetics, hypertension, cancer, arthritis etc.

4. Citizen Preparedness: Recognizing the increasingly role of individuals in their healthcare and as managers of healthcare problems and the significant role of PHR could facilitating communication between patients and clinicians, improving accuracy, of patient data (e.g., history), and providing new kinds of data that could inform health decisions and support research (e.g., diaries of patient experiences), public policy must also assure that citizen are prepared to use EHRs effectively. 5. Conclusion: Effective EHR at health institution level and PHR at personal level or responsible organization linking together and complementing each other will add value for accomplishing complete 360-degree information that would help providing comprehensive continuity of care to patient, at right time, at right place and at right cost. This system will not only facilitate in providing best possible timely healthcare, but also prevent duplication of investigations, medications, delay in care, check on risk and cost. Standardizing of PHR information is a must as the type of information it contains is a continuity of care and patient-focused record that allows practitioners from different settings and disciplines to share information and that allows the patient to carry this information with him or her upon referral, transfer, or discharge. The PHR can help with better understanding of the patients’ role as a partner with their provider. 6. References: [1] AHIMA e-HIM Personal Health Record Work Group “The Role of the Personal Health Record in the EHR.” Journal of AHIMA 76, no.7,July-August 2005: 64A-D. [2] Harold P. Lehmann and others; Aspect s of Electronic Health Record Systems Personal Health Record PHR, pp50-51,100, 153 [3] http://healthinsurance.about.com/od/glossary/ g/phr.htm [4] Margaret K. Amataykul “Electronic Health Records,” PHR 2004, pp 11, 206. [5] Mogli, G.D. “Managing Medical Records” Channel Publications, USA 1996, pp 6-7 [6] Mogli, G.D. “Medical Record Consultant’s Role in Implementing Electronic Health Record”. Published in Proceedings of 15th International Health Record Congress, held at Seoul, South Korea, 26-31 May, 2007 [7] Mogli, G.D.” Standardization of Paperless Health Record” published in Journal of IHRIM (UK); Vol 36, No.1, Feb. 1995, pp 10-12

86 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA QUALITATIVE Care Reviews T. Keshavarao. MBA (Hosp Mgt) BA, DMRT (BMC&RI) MRO (JIPMER) Asst,. Medical Records Offiicer Health and FW Dept. Govt of Karnataka

What is Audit? Planned and documented activity performed by qualified personnel to determine by Investigation, Examination or evaluation of objectives evidence. What is Medical Audit? Medical Audit is process that has been defined as quality improvement Standardization process. That service to improve the patient care and outcome through systemic review of care against explicit and implementation change. DEVELOPMENT OF MEDICAL RECORDS IN INDIA In 1950s importance was given for medical records development in India. In 1957 Dr.J.R.McGibbony (Rock feller Foundation.USA) visited India and he recommended to establish well developed MRDs in India. 1961 the Govt of India DGHS appointed Mudaliar committee for establishment of MRDs. 1962 CMC Hospital Vellore was Started MRT & MRO courses. 1966 Govt of India DGHS Starts well organized MRD in JIPMER Puducherry. 28 th February 1973 (DGHS CBHI) MRT Training and 1978 MRO Training programme started at Safdarjung hospital.New Delhi. 1977 MRO Course & 1979 MRT course (DGHS CBHI) started at JIPMER, Puducherry. The Government of Karnataka took keen interest to develop the Medical Records System in 1998. and started 2 year Diploma in Medical Records Technology courses under the Paramedical Board. Few examples of Data Sources of Quality care review Meet Medical Records, Morbidity Review and Mortality Review Evaluation of Clinical Services (Emergency, Nursing, ICU,RCU, NICU, Paed ICU etc,.) Infection Control Review Patient Complaints Policies and Procedures of Hospital, Date Schedule of Medical and Paramedical Staff, Reviews of Prescriptions etc…

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GOOD MEDICAL CARE GENERALLY MEANS A GOOD MEDICAL RECORD AND AN INADEQUATE MEDICAL RECORD OFTEN REFLECTS POOR MEDICAL CARE.

For this reason Medical Records is considered as one of the primary instrument to be used in measuring the quality of the medical care rendered by the hospital and its medical staff. Record control/Completeness also of of the quality assurance & Record control is a detecting the errors and correcting the errors. The first access of Medical Records in MRD is Assembling and deficiency check. Need for Deficiency check list? It is also one of the primary step to patient care review & quality control or Medical Audit. This kind of checklist indicates how many Incomplete Record found in the case sheets. It is most useful to complete the Medical Records forms accurately. What Contents there in the Deficiency check list? This is few examples of deficiency check methodology process. The first access of Medical Records in MRD is Assembling and deficiency check. Need for Deficiency check list? It is also one of the primary step to patient care review & quality control or Medical Audit. This kind of checklist indicates how many Incomplete Record found in the case sheets. It is most useful to complete the Medical Records forms accurately. What Contents there in the Deficiency check list? This is few examples of deficiency check methodology process. MEDICAL RECORDS DEPARTMENT ______HOSPITAL. Yes No 1 Final Diagnosis Y 2 Operation Procedure × 3 Consultation/Cross reference × 4 Result × 5 Cause of Death Y 6 Signature of Unit Head/Doctor Y 7 Discharge Summary Y 8 History sheet × 9 Gyn Maternity Sheet Y 10 Labor Room Record × 11 Anesthesia Notes × 12 Progress Notes × 13 Doctors Orders × 14 Treatment Chart × 15 Operation Start Time Y 16 Operation End Time Y 17 Elective OT Y

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18 Emergency OT Y 19 Name of the Operation × 20 Name of the Surgeon and Sign × 21 Name of the Anesthetist and Sign × 22 Consent Forms × 23 Pre antibiotic Prophylaxis × 24 Course of the treatment × 25 Post operative Diagnosis × 26 Pre Operative Diagnosis Y 27 Post infection Detected × 28 Blood units used × 29 Organs growth Y 30 Sensitivity Pattern Y 31 Deep Infection Y 32 Skin Preparations ×

Every MRD personnel should make Deficiency check list and Submit to higher authorities and present Monthly care review Meeting. Process of Deficiency Check. Collect Daily Admission list from the admission office. Discharge Analysis clerk should collect all discharge case records along with X-Rays, Late Investigation Reports. Verify all Discharge case Records as per the Discharge List. Arrange the Case sheets as chronologically standard order. And Send to filing section. Attach the Deficiency check list and MRT must tick the deficiencies in the check list. All assembled case sheets should forward the incomplete record control section. In the Month of September 2017 the hospital total Discharged Patients are2544 Ward Name Discharges D.Average % ge Ward Name Discharges D.Average % ge Med-A 85 3.03 Pediatric Med 101 3.60 3.97 Med-B 98 3.5 Gynaec-A 5 0.17 Med-C 99 3.54 Gynaec-B 12 0.42 Med-D 89 3.17 Mat -A 362 12.92 MICU 16 0.57 Mat- B 347 12.39 Med Trauma -- -- TOTAL 726 25.92 28.53 RICU 05 0.17 TOTAL 392 14 15.40 Ophthalmic 133 4.75 5.22 Surg-A 73 2.60 Psychiatric 21 0.75 0.82 Surg-B 48 1.71 Prisoner 19 0.67 0.74 Surg-C 43 1.53 Dental/Tr 3 0.10 0.11

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Surg-D 36 1.28 ENT 49 1.75 1.92 Paed SURG 05 0.17 Skin & VD 20 0.71 0.78 SICU 08 0.28 Tuberculosis 37 1.32 1.45 Burns 06 0.21 ID -- -- Surg Trauma 52 1.85 Leprosy 01 0.03 0.09 TOTAL 271 9.67 10.65 NRC 16 0.57 0.62 Ortho-A 56 2 NICU 65 2.32 2.55 Ortho-B 47 1.67 NBA-A 287 10.25 11.28 Ortho Trauma 12 0.42 NBB-B 269 9.60 10.57 Paed Ortho 16 0.57 Orphan -- -- TOTAL 131 4.67 5.1 Dengue 03 0.10 0.11 Total 2544 90.85 100%

Medical Records Technicians are Checked all case sheet Deficiencies at that time found following deficiencies

% of Total % of In complete Deficiency Completed Completeness Records found 1 Final Diagnosis 2100 82.54% 444 17.45% 2 Operation Procedure 360 79.99% 91 20% 3 Consultation/Cross reference 1526 60% 1017 39.97% 4 Result 2290 90% 254 10% 5 Cause of Death 103 80% 25 19.68% 6 Signature of Unit Head/Doctor 2290 90% 254 10% 7 Discharge Summary -- -- 2544 100% 8 History sheet 2540 100% - - 9 Gyn Maternity Sheet ------10 Labor Room Record 2035 80% 508 20% 11 Anesthesia Notes 315 70% 136 30% 12 Progress Notes 2544 100% -- -- 13 Doctors Orders 2544 100% -- - 14 Treatment Chart 2290 90% 254 10% 15 Operation Start Time 180 40% 270 60% 16 Operation End Time 180 40% 270 60% 17 Elective OT 90 20% 361 80% 18 Emergency OT 45 10 406 90% 19 Name of the Operation 270 60 181 40 20 Name of the Surgeon and Sign 270 60 181 40 21 Name of the Anesthetist and Sign 293 65 158 35 22 Consent Forms 1857 73 687 27 23 Pre antibiotic Prophylaxis 392 87 59 13

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24 Course of the treatment 2366 93 178 7 25 Post operative Diagnosis 312 69 139 31 26 Pre Operative Diagnosis 284 63 167 37 27 Post infection Detected 27 6 424 94 93.12 Not 28 Blood units used 175 6.8 2369 Used 29 Organs growth 30 Sensitivity Pattern 31 Deep Infection 32 Skin Preparations

Each and every hospital have to conduct this kind of audit and review meeting at least two months once and discuss the completion of Record & correct the deficiencies. Now days so many Health and Medical Acts came and all acts insists complete the medical records properly without mistakes. Now days all hospitals going on NABH accreditation. Medical Records Accurate/Proper Documentation also one of the primary requirements for NABH Accreditation & Quality Assurance Control . What is Incomplete Record Control? Verification of Patient Name, IP Number, Treating doctor Name, Final Diagnosis, Operation Procedure Consultations, Cross References, etc,. & shown above the deficiency check list. Check that all investigations are mounted, if not mounted, check the late investigation reports and mount them in a chronological order. Ensure that all the necessary forms such as the history, physical examination, progress notes, discharge summary, and other relevant forms are available in the patient file. Review each file thoroughly and check mark each deficiency noted on the deficiency check slip. Separate files according to treating physician and file them in as ascending order in the incomplete record cabinet for that treating physician. Arrange with the chief of units and set a day and time to review weekly discharge records. Model Time Table for Doctors Conference Room

Day/Time 1 0-11 am 11 am-12 pm 12-1 pm 2-3 pm 3-4 pm Monday Surg -II Med -II Gyn-II Ort-II ENT Tuesday MED -III SURG -III Gyn-III Ort-III ENT Wednesday GYN- I Med -I MED-I Ort-I ENT Thursday DENT PSY PAED SKIN Opth Friday DENT DENT OPTH PAED SKIN Saturday PSY OPTH PSY SKIN PAED

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Have all incomplete records ready on the appointed day and time, before the treating unit chief and his team of physicians/Surgeon visit the MRD to complete the records Clarify with the physician any doubts or discrepancies regarding the information in the patient file. Separate those patient files which are lacking investigation reports and attempt to collect these reports for record completion. Ensure that final diagnoses and associated diagnosis, if any, are entered. Also , in the case of surgical procedures, enter the names and dates of operation performed. Review completed records immediately and notify physicians of missing signatures and so forth. Annotate with a checkmark the appropriate number in the incomplete record control register. Forward these patient files to the to the inpatients coding unit and obtain their acknowledgement as a token of having received the files. MORTALITY MEETING List FOR THE MONTH OF Sept-2017

SL. NO NAME/AGE/SEX /IP NO/ D O A D O E DIAGNOSIS AND CAUSE OF DEATH WARD ADDRESS Time Time MMD A Rajakumar 10/9/2017 16/9/2017 C OPD WITH ARDS WITH CARDIO 1 IP NO-200865/65YRS/M 12.52PM 9 AM RESPIRATORY ARREST AT:Bangalore +48HRS

2 Balakrishna 11/9/2017 12/9/2017 CHRONIC ALCHOHALIC LIVER DEASE IP NO-201328/35YRS/M 3.10PM 1.15AM WITH ENCEPHALPATHY CARDIO AT:HOGARATI NEAR -48HRS RESPIRATORY ARREST DESHANUR BAILHONGAL BELGAUM 3 RAMESH 24/9/2017 24/2/2017 ASIS ANEAMIA WITH ALD ANAEMIA IP NO-201880/35YRS/M 5.16PM 5.50PM WITH ALD WITH HYPOTIC AT:Jayanagar.Bangalore -48HRS ENCEPHOLOPATHY WITH CARDIO RESPIRATORY ARREST MMD B Duryodhana 24-9-2017 27-9-2017 ASIS RVD WITH ALD WITH HEPATIC 4 IP NO-199879/35YRS/M 9.08PM 11.20AM ENCEPHALOPATTI CARDIO RESPI AT:Rajkumar Road. Kolar +48HRS ARREST 5 Sulochana 1/9/2017 8/9/2017 Rheumatic Heart Disease IP 124578/47 Yrs/F +48 Hrs With Mitral Regurgitation Nanini Laycout. Bellary With Congestive Cardiac Failure

MORTALITY REVIEW DISCUSSION C/C: Breathlessness since 8 days, Pedal edema since 8 days. History of present illness: Patient was apparently alright 8 days back the she developed breathlessness which was sudden in onset and progressive in nature It is present on doing routine work as well as at rest. It increases on lying down position. There are also complaints of swelling of both lower limb since 8 days, which is insidious in onset an progressive in nature. It is present up to knee from ankle

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.H/O palpitation present, regular, increases on decreases on exertion and decreases on rest, No H/O fever, Cough, and Chest pain. Past History: No h/o similar complaints in the past in the past. No h/o DM, HTN,TB No h/o any previous hospitalization Personal History: Diet Vegetarian, Appetite-Good, Sleep, Normal, Bowel and Bladder-Regular, Others-Nil. Family History: Nothing significant. General Physical Examination: Here is a middle aged female patient who is moderately build and nourished and conscious, co-operative and well oriented to time, place, and person. PR-80 beats/min, regular, high volume. BP-100/70 mmHg, RR-22 Breaths/min, Temp-A febrile, Pallor-Absent, Icterus-Present, Cyanosis-Absent, Clubbing-Absent, Lymphadenopathy-Absent, Edema-B/L pedal edema,++pitting type. Systemic Examination: CVS-S1 &S2 heard Normal, Pan systolic murmur and mid diastolic murmur present in mitral area no additional sounds. RS-B/L equal air entry present, B/L Basal crept present. Abdomen- uniformly distended, fluid thrill present. CNS-NAD Diagnosis: Rhumatic Heart Disease with Mitral Stenosis with Mitral Regurgitation with congestive cardiac failure. Investigations: HB-12mg%, TC-5500 cells/mm. ESR:10 mm at the end of 1 hour, Urine-Albumine-nil, Sugar-nil, Microscopy-NAD, USG Abdomen-Cystitis, Fatty Liver, Moderate Ascitis. Patient Stayed in hospital 7 days and during that time she had given treatment as follows: Inj-Lasix 1 ample IV, Inj Vit-K 1 amp in OD for 3 days, Inj BC 2cc in ATD,Inj Taxim 1 mg IV, Inj Deriphylline 1 amp IV, Inj Rantac 1 amp IV, Inj Perinorm 1 amp IV, Tab.FS, Tab BC, Tab Liv 52. Cause of Death-Cardio Respiratory arrest secondary to CCF with history of RHD. Date of Death:8/9/2017 at 3pm Conclusion Many Hospital in India has not doing Medical Audit and Qualitative Care reviews. So it is very essential for Hospitals for quality care and Patients Care purpose. Without Medical Records and Qualified MRD Professions cannot make Qualitative Reviews and All hospital has required for qualified Medical Records Professionals for improve the quality care for the hospitals,

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GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA The Significance of the Transition to the Electronic Medical Record Ms. Mallika Kothandaraman M.A., M.A., B.M.R.Sc., PG DHA WHO Fellowship Medical Record Officer-cum-Tutor (Rtd.) Department of Medical Records, JIPMER, PONDICHERRY-605 006.

PREAMBLE: Electronic Medical Records can be defined as the computerized database that stores information of a person regarding to personal and health issues, for providing the continual and immediate care and billing. The information is utilized among the local area networks or both, the regional and national level. The EMRs’ are expected to be both ambitious and achievable i.e., EMR system attempts towards moving the health management systems in a forward direction, towards improved quality and effectiveness in health care. But making such a progressive move focusing on higher position or betterment must also contain a check points that serve as measuring instruments to see the accuracy of the progression and also to reflect the capacities of health care providers who face a multitude of challenges. ELECTRONIC MEDICAL RECORDS are the digital version of the paper charts in the health care facility centre. An EMR contains the life history of the patient in the medical point of view. EMRs have advantages over paper records. It allows to: • Data tracking along the time line; • Easily summarized tests that are due for the patients, i.e., preventive analytics and checkups; • Monitor the patients’ profile on the basis of specific parameters; • Evaluation and improvisation of the health care sector and its activities. EMRs’ might have the privilege of being printed and mailed to specialists and members the care team, but information in EMRs doesn’t travel easily out of the practice. Regarding this point, the EMR are found to have a drawback on comparing with the paper records. An ELECTRONIC HEALTH RECORDS (EHR) is a digital version of a patient’s paper record. EHRs’ are real time, patient providing ready information securely to the authorized users. EHR can: • Contain a patient’s health history, diagnoses, medications, treatment plans, immunizations dates, allergies, radiology images and laboratory and test results; • Allow access to evidence based tools that providers can use to make decisions about a patient’s care; • Automate and streamline provider workflow. HEALTH CARE QUALITY & CONVIENIENCE: • Quick access to patient records from inpatient and remote locations for more coordinated, efficient care; • Enhanced decision support, clinical alters, reminders and medical information; • Performance – improving tools, real time quality reporting; • Legible, complete documentation that facilitates accurate coding and billing; • Interfaces with laboratories, registries and other EHRs; • Safer, more reliable prescribing. 96 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA

I. PATIENT PARTICIPATION: • Ensures high-quality care: It enables the health care providers in giving full and accurate information about all the medical evaluations to the patients. It also helps the providers in following up information after the visit or hospital stay, such as self-care instructions, reminders for other follow up care and links to other health care providers. • Communication with their patients: With EHR, the providers can manage the appointment schedules electronically and exchange e-mail with their patients. Quick and easy communication is assured and may help the providers to identify the symptoms earlier. And it can position providers to more proactive by reaching out to patients. II. IMPROVED DIAGNOSTICS & PATIENT OUTCOMES: • When health care providers have access to complete and accurate information, patients receive better care. EHR can improve the ability to diagnose diseases and reduce - even prevent - medical errors, improving patient outcomes. III. IMPROVE CARE CO-ORDINATION: • EHR can show tremendous reduction of the storage of different parts of care by improving care – health co-ordination. EHR has the potential of integrating and organizing patient health information and in facilitating its instant distribution among all authorized providers involved in a patient’s care. For example, EHR alters can be used to notify providers when a patient has been in the hospital, allowing them to proactively follow up with the patient. • Using EHR helps every provider have to accurate and updated information about a patient. This especially important with patients who are: • Attended by multiple health care providers / specialists; • Making transitions between health care centers; • Receiving treatment under emergency centers. • Better availability of patient information can reduce  Medical error and unnecessary tests;  The chance that, one specialist will not know about an unrelated (but relevant) condition being managed by another specialist; • Better care coordination can lead to better quality of care and improved patient outcomes. IV. ELECTRONIC HEALTH RECORDS CREATE MORE EFFICIENT PRACTICES: It enabled medical practices report: • Improved medical practice management through integrated scheduling systems that link appointments directly to progress notes, automate coding and managed claims. • Time savings with easier centralized record management, condition-specific queries and others. • Enhanced communication with other clinicians, labs and health plans through: • Easy access to patient information from anywhere; • Tracking electronic message by authorized health care providers; • Automated format checks by health plans;

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• Order and receipt of lab tests and diagnostic images; Links to public health systems such as communicable disease and non-communicable disease databases. It focus on the health of the patient going beyond standard clinical data collected inclusive of a bird view on a patient’s care. EHR are designed to reach out beyond the health organisation that originally collects and complies the information, and to share them with other health care providers, suchas laboratories and specialists, so they contain information from all the clinicians involved in the patient’s care. EHR data “can be created, managed and consulted by authorized health care providers and across more than one health care facility centers. The information moves with the patient to the health care provider or even across the country. EHRs designed to be accessed by all involved in the patients’ care including the patients themselves. And that makes all the difference. Because when information is shared in a secure way, it becomes more powerful. Health care is a team effort and shared information supports that effort. After all, much of the value derived from the health care delivery system results from the effective communication of information from one to another and ultimately, the ability of multiple to engage in interactive communication information. ADVANTAGES OF EHRs: With fully functional EHRs, all the health care providers have readily access to the latest information allowing for more coordinated, patient centered care. With EHRs: • The information gathered by the primary care provider tells the emergency department clinician about the patient’s life threatening allergy, so that care can be adjusted appropriately, even if the patient is unconscious; • A patient can log on to his own record and see the trend of the lab results over the last year, which can help motivates him to take his medications and keep up with lifestyle changes that have improved the numbers; • The lab results run last week are already in the record to tell the specialist what he / she needs to know without running duplicate tests; • The clinician’s notes from the patient’s hospital stay can help inform the discharge instructions and follow up care and enable the patient to move from one care setting to another more smoothly. So, yes, the difference between “electronic medical records” and “electronic health records” is just one word. But in that word there is a lots of difference. A meaningful use of compliant healthcare solution for small, large and multi-location practices. CONCLUSION: The paper records are limited, the problem with a paper record, the handwriting is illegible and the document cannot be electronically shared or stored. It is not structured data that is commutable and hence sharable with computers and systems. Other shortcomings of paper: expensive to copy, transport and store; easy to destroy; difficult to analyze and determine who has seen it; and the negative impact on the environment. Electronic patient encounters represent a quantum leap forward in legibility and the ability to rapidly retrieve information. Now computerized and digitized for rapid data retrieval and trend analysis. The main idea of standards is to build up a system, which would authorize one to generate, to provide support, receive or transmit digitally using trustworthy medium for storage data and transmission. Electronic health record can provide the complete history of patient’s health to acquire the right decision. To achieve meaningful use, providers must follow a set of criteria that serve as a roadmap for adequately implementing an EHR.

98 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA Analysis of Trauma Patients Flow at JPN Apex Trauma Centre, AIIMS, New Delhi Ramesh Kumar Kaul (MRO), Dr. Amit Lathwal & Dr. Adarsh Kumar (F/I/Charge MRS)

Introduction: JPN Apex Trauma Centre, AIIMS is an apex trauma Centre in India. It has 186 in-patient beds, and daily average attendance of 172 new patients. The centre is losaded with all ultra-modern medical, diagnostic, surgical and rehabilitative machines & equipments, with 24x7 hr promptly available for Acute and critical injured, trauma patients. Team-work is essence of this centre. Which includes Trauma Surgery & Critical Care, Emergency Medicine, Orthopedics and Neurosurgery Deptt. AIM: The aim of this study is to analyses and evaluates the Trauma patients flow during CY 2012-16 at JPN Apex Trauma Centre. METHODOLOGY: For this study a well planned and comprehensive questionnaire was prepared and desired Data was collected from various patient facility counters within Centre, like :Patient Central Registration Counter, Emergency Medicine Deptt. OT, ICU, Ward FOPD and MRD. The Data collected had undergone various Statistical Tools & Tests: K2,Average, percentage, Measures of Central Tendency and Data presentation has been done in tabulation form also. RESULT: There is a 06% annual incremental growth in Trauma patients registration. There were 172 pts. daily average attendance during year 2012-16. More NMLC cases were registered than MLC cases. The unique Triage system had been adopted here with Color codes: Green, Yellow, Red & Black at EM Deptt. Wherein, Patients with minor injury are treated in Green triage area, Moderate in Yellow, Serious patients in Red Area and Patients received as Dead-Body in Black Area. It was seen during study that more Green Triage patients (2,22,451) (73.5%) had been treated, Yellow(62,995) (20.8%),Red. (17,081) (5.6%) and Black(1471). In-patient Admission Data Shows that during 2012-16, that the maximum No of patients were Admitted into Trauma Surgical & Critical Care (TS & CC) wards (9715 pt.) (36.8%) , next in Neurosurgery wards.(9117 pt.) (34.5%) 3rd in (Ortho wards 7545 pt.)(28.6%). From the Operation Data , it had seen that Maximum No. of Operations had Done by TS&CC Deptt. 10,837 (39.3%), Ortho. 9856.(35.7%) Neurosurgery 6877 (24.9%).It was found in Trauma Centre that More Major Operations (25,834 cases) has done than Minor operations (2014 cases) during study period. From FOPD Data , it is seen that Maximum No. of Patients had been seen in Ortho Deptt. 93,5979(54.34%), TS & CC. 44,537(25.85%), NSx. 31,901(18.53%) and Others Deptt/s 2193 (1.27%) .From the Patients Post- Hospitalization approach towards Legal Help Data: it had seen that only a (6.3.%) of patient approach

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for legal help out of total patient registered at CRC. From the Patients Post-Hospitalization approach towards Insurance claims Data: it had also seen during the study that only (0.07%) of patient claimed Insurance claims out of total registered patients at CRC. From Hospital Performance Indicator Data: it was found during study that the Average GDR remain (11%) NDR (05%), ALSO (11 day), BTOR (29 pt/bed.) and BOR(84%). Analysis: During the study period, it was seen that Trauma patients are increasing in numbers day-by-day, it could be due to Heavy Traffic , Road Traffic Accidents (RTA) , fast Industrialization, (Industrial Accidents IA) , Fast Urbanization, Heavy Population growth ( Domestic Violence, etc) Discussion: During the discussion, it was seen that some in-house measure can be taken within centre, but major measures need to be discussed with external agencies for implementing proper guidelines/ procedures /rules/etc for Road traffic, Construction work, Population awareness, etc. Conclusion: There is a 06% annually incremental increase in Trauma patients. It was found a strong need to strengthen or open Trauma care Facility Centers at all Secondary and Tertiary care Healthcare centers/ providers in Country. Message: Be-careful and avoid Accidents. Key word/s: Trauma patient, Trauma Surgery & Critical care, Orthopedics, Neurosurgery. References: JPNATC MRD Annual Audited Data, Trauma Systems, Hospital Statistics.

100 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA Health Information Management role in Quality and Patient Safety Mr. Madhu Mohan Maddirala Medical Records Officer, ACTREC, Tata Memorial Centre, G overnment of India, Navi Mumbai, India Email - [email protected] Mobile: 9920978102

Health Information Management (HIM) provide services in all aspects of records management – including data collection and data quality management, integrity, standards, disclosure, coding, disposition, and privacy of health information. The HIM department perform detailed analysis of the information in the health record to facilitate health care delivery, patient safety and decision support & play a role in ensuring the confidentiality of health information within the patient record and are advocates of the patient’s right to private, secure and confidential information. HIM professionals are essential in quality programs, and provide guidance on documentation, communication, eHealth implementation, EHR infrastructure, and policy issues. Health data is coded and used for analysis by organizations such as the International classification of diseases (ICD), Hospital decision support departments use the adverse events, Hospital Standardized Mortality Rates, complication rates, in-house infections etc. – to improve how they treat patients. Long in the forefront of healthcare sustainability from a reimbursement standpoint, HIM professionals have a unique opportunity to support the growth, from small data management efforts to true organizational information management. Clinical documentation improvement (CDI) functions. Clinical documentation in the health record is critical to the patient, the physician, and the organization. Acute care hospitals. HIM can provide support for the following CDI functions: Identifying and clarifying missing, conflicting, or nonspecific physician documentation related to diagnoses and procedures. Supporting accurate diagnostic and procedural coding, severity of illness, and expected riskof mortality, leading to appropriate reimbursement. Promoting health record completion during the patient’s course of care Improving communication between physicians and other members of the hospital staff and providing education. Improving documentation to reflect quality and outcome scores Improving coders’ clinical knowledge. Standardizing data and its capture enables the creation of reports that will accurately reflect patient treatment and outcomes. Leveraging the use of national data standards within their organization: HIM professionals should identify what national data standards exist and ensure that these standards are being used throughout the organization wherever possible. When local or institutional

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standards need to be developed, these should be well documented as to their rationale and relationship with any corresponding national standard. Participating in national or local initiatives to develop and promote data standards, quality measures, and patient safety programs: HIM professionals should identify opportunities to participate in standards development or reviews at the local, state, or national level. A number of organizations, including Health Information Management Association (HIMA) India, HERAI, MCI, DGHS, AHIMA, & National Quality Forum provide opportunities to review and comment on new and revised standards and quality and patient safety measures. The EHR will provide a greater opportunity for access to healthcare data. Working with standards organizations and providing feedback on new or revised standards provide HIM professionals with an opportunity to provide practical information on how well the standards will work, what modifications may be needed to make the standard more effective, and ensure that organizations can achieve the standard. “Over the years I have been most fortunate to serve in different capacities that contribute to patient safety. As a Medical Records Officer, I provide indicators and analyses from our incident and infection control data to our clinical teams to assess safety and risk. Leading the hospital accreditation process in the past included working with all teams to ensure that standards around patient safety were addressed. This included workflow analyses, staff education, communications and policy revision. “I truly feel that HIMs in all capacities greatly contribute to patient safety. From the core coding staff that collects data that provides much of the foundation for decision-making to the actual strategic level decision-makers. We all have our roles to play and I am proud to play mine every day.” HIM coders – who bring strong biomedical science education, coding classification and abstracting knowledge – collect data from hospital visits (acute, ambulatory care, rehab, etc.) and codify the data using the International Classification of Diseases.(ICD) As active participants in patient safety in a transforming Electronic Health Record (EHR) environment, HIMs champion patient safety and quality care by advocating for and managing complete, timely, accurate, and meaningful data. The HIMA India requires all certified HIM professionals to participate in continuing professional education, ensuring HIM professionals maintain their knowledge, awareness of evolving data, new EHR developments, infrastructure innovations, and standards related to eHealth transformations, supporting their role as data and information stewards. HIM professionals play an important role in patient safety as hospitals and ministries use the data they collect and analyze to: • Ensure that patient information is secure and protected. • Improve healthcare quality by reducing medical errors, health disparities, and by advancing the delivery of patient-centered medical care. • Reduce healthcare costs resulting from inefficiency, medical errors, inappropriate care, duplicative care, and incomplete information. • Provide appropriate information to help guide medical decisions at the time and place of care. • Improve the coordination of care and information among hospitals, laboratories, physician offices, and other entities for the secure and authorized exchange of healthcare information. • Improve public health activities and facilitating the early identification and rapid response to public health threats.

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• Facilitate health and clinical research and healthcare quality. • Promote early detection, prevention, and management of chronic diseases. “As the ehealth record gets rolled out across India, the role of the certified health information management professional will become increasingly important in ensuring our health information is protected, and properly managed,” Without certified professionals doing the work, more errors occur, data is compromised and patient safety is at risk. As our health records go paperless, the privacy, confidentiality and safety of those records need to be managed by a certified HIM professional in order to ensure the best patient care. The transition of quality and patient safety measures from claims based or manual collection to electronic is escalating. More than ever HIM professionals need to provide the expertise on the data and the systems being implemented in their organizations to make sure that the electronic measures can capture the same or similar data to still represent the intent of the measure

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With Best Compliments from

SREE UDHAYAM CHEMICALS R.s.no.133 / 1, Mangalam Village, Villianur Commune, Pondicherry - 605110. Puducherry

103 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA Challenges of EHR Adoption-Implementation

Yuvaraja Senthamaraikannan, M.Sc,PGMRT,PGDMLT,DWAD Office Assistant Central Bureau of Health Intelligence MRD training centre, JIPMER [email protected]

Abstract Background/Objectives: Electronic Health Record are unique electronic documents composed of information like patient history records, demographics, prescribed medications, laboratory reports and computerized tomography etc. to pertaining the patient health care. The main objective of the paper is to review the present adoption rate of EHR in India with respect to global market. Methods/Statistical Analysis: EHR is the key component for the clinical decision support system .To review the current scenario of adaption rate of EHR, bibliographic learning was obtained from many hospital sources. In addition, contact was made with EHR vendors. Findings: During the pilot study of major hospitals encounters in which successfully the EHR system has been implemented. Globally the adoption rates of EHR in major countries are China (96%), Brazil (92%), France (85%), and Russia (93%) in this respect. In year of 2020, globally Market of electronic health records will place at US$25.98 billion as per the reporting of CAGR. Interoperability standards issues, lack of funds, shortage of suitable governance health policies are the major barriers in adoption of EHR in India. Application/Improvements: Adoption and implementation of EHR should be made mandatory in large sized and medium sized hospitals. In upcoming years EHR system require to incorporate a framework of standards, latest tools and consolidation of system providers. 1. Introduction • Government of India’s ‘The Digital India Healthcare’ initiatives making their way into policy. We believe that the increased utilization of health IT products and its acceptance is one of the key to implement the vision on digital India. • Major objective of the new initiative is to encourage health Information technology, for improvement of a digital infrastructure for providers as well as patients so that care can be delivered more effectively and adequately. • Indian Government has been considerable interest about the Electronic Health Records (EHR). EHR and EMR are the leading technologies that are primarily used to supervise the patient’s health information. However, both are more or less the same with the slight difference being that EMR (Electronic Medical Records) is mostly used by a healthcare organization whereas EHR collects the patient’s information from different sources. • The EHR is in digital format about a distributed personal health record that provides confined, real- time, patient-centred information includes UUID information (e.g Aadar Card), diagnosis history, lab reports, immunization dates, allergies, and images that are useful for making clinical decision. • EHR systems can improve the physician competence and minimise costs, as well as encourage evidence-based medicine. Most prominent feature of an EHR is that, digital record can be modified, formed, and handled by authoritative vendors and staff. With the help of interoperatibility data can be share across more than one health care organization.

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• In 2013, Ministry of Health and Family Welfare notified EHR standards for India. Some organizations are at the forefront of the curve. From decades, they have been adopted electronic records while rests are still in the planning phase. Historically, on basis of the survey, taking up of EHR has been considerably lesser in India as compare to other developed nations. To enhance the acceptance & to influence its returns, the Government of India has budgeted $19.2 billion for HIT. • Worldwide there is a distinction in adapting of EHR in the health care systems e.g, China (96%), Brazil (92%), France (85%), and Russia (93%), have been noticeably booming in this respect. At present in India, adoption of EHR system is • Thus, in this study I present, 1. An outline of the existing scenario and challenges for adoption of EHR, 2. the estimated growth of EHR 3. The roadmap towards significant use of conformity, and provide an overview, that how significant transition should prepare for adaptability of EHR by the organizations. Motivational benefits of EHR/EMR are: • Patient information can be securely share anywhere at any time with help of EHR. • Staff and clinicians can make the direct entry, reduces transcription cost. • Quality documentation can be maintained (perceptible, readable, records, reports and charts). • Reduce the issues of prescription of incorrect medicines. • Complete patient history records improve the cure outcomes. • These systems greatly aids the physician for immediate patient treatment by capturing the key records. • EHR records are the key data for implementing the clinical decision support system. The major barriers in the adoption of EHR are: I. Interoperability standards issues II. lack of funds III. shortage of suitable governance health policies. Despite of high concern by the Government of India on adoption of EHR, impetus is still to be recognized. 2. Electronic Health Record Adoption Rate As per Healthcare Information and Management Systems Society Asia Pacific, there are eight stages/levels of acceptance of EHR varying from level 0 to level 7. Stages of HIMMS EMR Adoption Model Asia Pacific

Stages Cumulative Capabilities 2015 Q3 2015 Q4 Stage 7 Complete EMR, Data Analytics to improve care 0.4% 0.5% Physician documentation(Templates),Full CDSS, Closed Loop Stage 6 3.4% 3.9% Medication Administration

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Stage 5 Full R-PACS 8.0% 7.4% Stage 4 CPOE, Clinical Decision Support(Clinical Protocols) 1.7% 1.7% Nursing/Clinical Documentation, CDSS (error checking), PACS Stage 3 0.7% 0.6% Available Outside Radiology Stage 2 CDR, Controlled Medical Vocabulary, CDS, HIE Capable 32.9% 32.7% Stage 1 Ancillaries-Lab, Rad, Pharmacy-All Installed 4.6% 4.9% Stage 0 All Three Ancillaries not Installed 48.4% 48.2%

At Stage 0 there is small or nil acceptance while at Stage 7, complete implementation or acceptance. With reference to the HIMSS analysis adoption model of EHR, by the end of 2017, only 2.6% of hospitals were crossed the Level 6. Up to year of 2020, at stage 7 approximate 1.5% of the hospitals of India are measured completely functioning. At stage 7 paperless work will be there to deliver and manage patient care. At present scenario, a bigger cluster of hospitals (31%) were measured at Level-3. It’s a positive sign. However, hospitals cannot realize considerable quality or cost benefits at Stage-3 because still considerable paper based work at this stage. A larger implementation investment requires after Stage-3, a assurance to which very few hospitals have been able to meet. Additionally, exchange of data information among hospitals was complex because of lacking of interoperability standards among hospitals, which creates the big hurdles among the co-ordination of patient care. These barriers, along with deficiency of regulatory momentum, are the major barriers for industry in adoption of electronic health record widely. By considering these challenge/barrier Ministry of Health and Family Welfare committee has recently developed a broader definition for hospitals move to Stage-6 and 7 in future. Despite previous challenges, there are reasons for broader implemention of EHR: i. EHR technology is the centre of change in healthcare evolution. Electronic health record will grow to be a viable escort for hospitals. The hospitals with slow adoption will be left behind. ii. For implementation of electronic health record prompt inducement will assist inhabit up a ample segment of the technology investments. Survival in competitive market will be tough to stay. iii. Scope and broader spectrum of EHR, including the exchanging of patient information, firmly to improve the quality care, efficiency and productivity, and ease a better interoperability of patient information across the hospitals. Centralized fully realized EHRs record having which includes the patient’s health information: which is absolute, rationalized and precise. It will improved the return of investment and in turn increased adoption rate of EHR. iv. Overall inspiration of EHR is, the ability to quickly provide care and to make good decisions. With EHR adoption all benefits will attain all stakeholders in the nation, including, physician, vendors, patients and society as a whole. v. In 2013, the Ministry of Health and Family Welfare, notified the strategy for electronic health record which are the guidelines for EHR service providers to make sure that patient digital data become portable and easily redeemable. The market of Indian healthcare, currently invest amount of USD forty Billion in the healthcare industry. For the pharmacies investment is approximately 50%, around 25% for insurance, approximately 15% ford medical equipment and 10% for the diagnostics. These criteria provide an influential tool with the prospective for remarkable excellence in the area of quality and care.

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Some of the key challenges/barriers to acceptance of EHR are as follows:-

Current Barriers/ Comments Challenges Most of the patient records are paper based documented except few of well Legacy System known private large scale hospitals. Its a difficult task to convert this paper based record to electronic format. High cost of implementation is the foremost barrier. Only hospitals or physicians Cost with high IT budget can afford these systems. To promote the implementation of EHR, there is absence of co-ordinated policy Policy of Government. Lack of clarity in the existing policies of HIT Government funding for HIT is almost non-existence. One of the factor leads to Funding lack of adoption of system. Another factor is lack of well trained professional in medical informatics. For exchange of information and representation, most of system don’t adhere Standards to standards. It will be further complicated, because of multiple local languages used by patients and staff Computer literacy is low among the government staff and private hospitals Computer Literacy community. System training is required to properly usage of the EHR. Co-ordination and Lack of co-ordination and supporting infrastructure (including the hardware and Infrastructure software) among the public and private sectors hospitals. Judicial of India has not addressed any specific right of privacy issues with respect Privacy Concerns to the patient health record. Confidentiality of patient health record is still an open area.

3. Meaningful Use of EHR Implementation of Electronic Health Records (EHRs) is not federally mandated in India, inspite of that we have started discussing about it in India is itself a very good mark. Meaningful Use encourages to migrate from paper charts to digital records while providing the best care to the patients. It improves practice’s efficiency and will give prominent outcomes. The main idea of standards is to build up a system, which would authorize one to generate, pile up, receive or transmit digitally using trustworthy medium for storage of data and transmission. Electronic health record can provide the complete history of patient’s health to acquire the right decision. To achieve Meaningful Use, providers must follow a set of criteria that serve as a roadmap for adequately implementing an EHR. On 2014, public remarks on Meaningful use had been projected a range of concerns regarding the requirements of EHR which includes the necessity to improve the earlier culture prior to CPOE incomplete order entry systems, and time bound restrictions. The first logical step in Meaningful Use is to conduct an audit (assessment) of the organization, what is the present status and what efforts are required to comply with goals mention in Meaningful Use. On the basis of the audit outcomes, blueprint for an EHR implementation, the required amendments plan can be developed. Technical aspect used for implementation is based on the specific plan implementation, broader aspects, including the ability to provide interoperability among the other organizations, number of modules to be included etc. For exchange of data among other organization will need to be developed in association with other organizations. As per my perspective, the industry of healthcare isonthe boundary intended for a move where EHR based organization will no longer be an option. In future, for

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hospitals deliverance through utilize of EHR based system will turn into the default system. As per survey, the hospitals that have adopted EHR systems have been perceived as more efficient and consistent. 4. Glance of Global EHR Market According to Transparency Market Research (TMR), the industry of healthcare in the middle of a ample move from paper based to digital based, which in turn upshot the enhancement of the EHR20,21 worldwide. Globally Market of electronic health records will place at US$25.98 billion in the year of 2020 as per report by a CAGR. Mainly in the United Kingdom and United State, continuous efforts are going on to accelerate this evolution across the whole public and private healthcare network. The United States will remain the largest EHR market in the Americas and globally as per the report of Accenture. The EHR Incentive Program offering both incentives for compliance and penalties for non-compliance if EHR system not used. In comparison to Asia Pacific, the EHR market of the Middle Eastern, European, and African is supposed to be lead by value of $7 billion approximately. Figure depicted the globally overview of EHR market.

4. Conclusion The Adoption of EHRs will surely boost the competence of healthcare systems but on the other side several parameters like lack of standards, cost, guidance, security and confidentiality, could remain a concern. For well -built healthcare and wider range of benefits of EHRs, the government support to provide incentives act like boosters to promote the market of EHR adoption. The adoption challenges today we are facing are complex and solution to these challenges is not so quick and simple. National policies are required for stability regularity of these problems. We recommended that mandatory in large sized and medium sized hospitals. More innovative approaches like web based and cloud based solution can be used. References: Asia Pacific Report. Available from: http://www.himssanalyticsasia.org/. Stages of HIMMS. Available from: http://www.himssanalyticsasia.org/about/press.room-pressrelease17.asp Analytic Report. Available from: http://www.healthcareitnews.com/directory/himss-analytics Regulations and Guidelines. Available from: https://www.cms.gov/Regulations-and- Guidance/Legislation/ EHRIncentivePrograms Government of India and coordinated by FICCI on its behalf. Recommendations on Electronic Medical Records Standards in India. EMR Standards Committee, constituted by an order of Ministry of Health & Family Welfare, 2013.

108 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA Interoperability in Healthcare: Benefits, Challenges and Resolutions Mohammed Shazman S. Kanthavel MRO Trainee MRO Trainee [email protected] [email protected]

Sunil B.P Vanga Ravinder MRO Trainee MRO Trainee [email protected] [email protected]

Under the guidance of A. Lakshmanan Statistician cum demonstrator, MRD, JIPMER Puducherry

Introduction Since the 1990s, advances in Information and Communication Technologies (ICTs) in healthcare have created new ways of managing patients’ information through the digitization of health-related information. The use of ICTs in healthcare has the potential of reducing medical errors, improving collaboration between healthcare providers, reducing the cost of healthcare and dramatically improving the delivery and quality of healthcare. The enhancement of ICTs in healthcare has also led to the generation of huge amount of information relating to the diagnosis, testing, monitoring, treatment and health management of patients, billing for healthcare services and asset-management of healthcare resources. This information is stored in heterogeneous distributed Health Information Systems, in different file formats which are mainly proprietary Numerous solutions have been proposed to achieve total interoperability in the healthcare with degrees of success. These include the use of standards, archetypes, web services, healthcare service bus, and interface engines and ontology’s. However, in spite of these diverse solutions, interoperability within the healthcare domain is yet to be completely achieved Concept of Interoperability In broad terms, interoperability is the ability of different information and communications technology systems and software applications to communicate, to exchange data accurately, effectively, and consistently, and to use the information that has been exchanged In general, there are seven basic levels of different levels of interoperability . These levels include: Level 0 or No Interoperability: This is usually characterized by stand-alone systems which have no interoperability Level 1 or Technical Interoperability: This level of interoperability involves the use of a communication protocol for the exchange of data between systems. Technical interoperability establishes harmonization at the plug and play, signal and protocol level. Level2 or Syntactic interoperability: This is the ability of two or more systems to exchange data and services using a common interoperability protocol such as the High Level Architecture (HLA).

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Pragmatic Interoperability: This level of interoperability is achieved when the interoperating systems are aware of the methods and procedures that each other are employing. This implies that the use of the data or the context of its application is understood by the participating systems. Dynamic Interoperability: Two or more systems are said to have attained dynamic interoperability when they are able to comprehend the state changes that occur in the assumptions and constraints that they are making over time, and they are able to take advantage of those changes. Conceptual Interoperability: Conceptual interoperability is reached if the assumptions and constraints of the meaningful abstraction of reality are aligned. The Critical Needs For Interoperability In Healthcare The healthcare domain currently is undergoing a fundamental change in its approach to delivering care as ICTs is becoming an indispensible component of healthcare. However, with the rising cost of healthcare, incessant inefficiencies and healthcare quality failures experienced by healthcare providers and patients, there is a need to understand the critical role that interoperability plays in data sharing and re-use among disparate healthcare applications and devices, reduction of healthcare costs and the improvement in the quality of care. Thus, this section critically appraises the benefits of complete interoperability in healthcare. Easy Access To Patients Records Patients usually get care from a wide range of care givers (such as hospitals, laboratory, pharmacy, urgent care centers, physician group, solo physicians and nurses, school clinics, and public health sites) based on their proximity, bedside manner, quality of care received and cultural attitude. This has led to the fragmentation of the patients’ information in proprietary heterogeneous systems across healthcare organizations. Consequently, vital information stored in these systems cannot be easily accessed to present a clear and complete picture of the patient. Easy Comprehension of Medical Terms The application of interoperability in the healthcare domain will provide care givers withthe ability to better understand terms and concepts as data is transmitted from one system to another, while preserving the meaning of the content. Thus, interoperability will contribute to the improvement

PUBLIC HEALTH DEPARTMENT

ELECTRONIC PHARMACY HEALTH RECORD PATIENTS INFORMATION (MRD) PERSONAL HEALTH RADIOLOGY RECORD

LABORATORY

110 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA of healthcare because it ensures that the right meanings of medical terminology are delivered to communicating systems. Hence, physicians can easily analyze data from all collaborating systems for diagnosis and decision making. Reduction of Medical Errors The delivery of healthcare often involves moving the locus of care among diverse sites and providers. Hence, patients’ records are scattered across several physicians’ offices, laboratories and hospitals. This process is usually fraught with errors as a result of lack of interoperability among healthcare systems. For instance, a study conducted in an inpatient setting estimated that 18% of medical errors that result in an adverse drug event were due to inadequate availability of patients’ information. Privacy and Security Policies Privacy and security policies should be considered as a part of design of an interoperable healthcare system. Healthcare Policies must be widely agreed by patients and practitioners on the terms and conditions for access to and dissemination of patient data. Adequate protection for the privacy of health information should also be considered in the development of interoperable healthcare system. Legislation and regulation should be frequently considered to reevaluate emerging technologies and capabilities. Also, authentication techniques such as passwords, fingerprints, retina scans and biometric devices such as fingerprint readers and voice-scanning systems should be used to help ensure data and networks are secure. Barriers to Interoperability in Healthcare There is no doubt that interoperability has a major positive impact on healthcare. However, the lack of interoperability in healthcare systems and services has long been identified as one of the major challenges in healthcare. For instance, a practitioner in a private practice may have difficulty obtaining complete information about a patient who is currently being hospitalized; also a practitioner may repeat tests and procedures because he or she does not have prior information about the patient. Consequently, this section appraises the barriers impeding interoperability in healthcare. Conclusion The major goal of interoperability in healthcare is to facilitate the seamless exchange of health- related information amongst caregivers and patients for clinical decision making. However, interoperability within the context of healthcare is yet to be realized. Thus, the lack of interoperability amongst healthcare systems further strengthens the information silos that exist in today’s paper-based medical files, which results in proprietary control over health information. This has resulted in increased healthcare cost, declining quality of patients care, and the inability to integrate patients’ information across healthcare systems. Consequently, this paper appraised the concepts of interoperability and its relevance to healthcare and attendant challenges. The paper also suggests solutions to achieving interoperability in healthcare.

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GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA Development of Morbidity Coding in Indian medical systems viz., Ayurveda, Siddha and Unani in line with Chapter 23 on Traditional Chinese Medicine, W.H.O-ICD-11 Mr. Shaik Abdul Rahaman, Sr. Medical Records Officer, All India Institute of Ayurveda, Ministry of AYUSH, Govt.of India, New Delhi,

Dr. T. Saketh Ram R.O (Ay.), National Institute of Indian Medical Heritage (NIIMH), Hyderabad.

Introduction: Medical classification, or medical coding, is the process of transforming descriptions of medical diagnoses and procedures into universal medical code numbers. Statistical classifications and nomenclature are the two variants of medical coding. ICD-10 belongs to the first category. Though ICD-10 is very comprehensive compared to its earlier versions, the revision of ICD-11 version, which was officially announced during October 2016, has two characteristic feature viz., 1. Definition of each coded entity 2. Inclusion of a chapter no. 23 on Traditional Chinese Medicine. This marks the beginning of official entry of alternative systems of medicine in ICD Classification. Keeping in track of the events, Ministry of AYUSH, Government of India, which regulates the education and practice of Ayurveda, Yoga &Naturopathy, Unani, Siddha and Homoeopathy in India, has initiated the process of developing Ontological frame works and morbidity coding for Ayuveda, Siddha and Unani (ASU) systems of medicine. It is pertinent to note, that till date, there is no centralized mechanism to capture the morbidity statistics from AYUSH Segment in India. The reason for this was lack of systematized nomenclature and morbidity coding in ASU systems. Methods: The fundamental premise of developing ontological classification w.r.t. ASU systems is to capture narrative of “Disorders” and “Patterns” described in classical literature of as recorded by Vaid/Hakim. To achieve this, Ministry of AYUSH has constituted sub-committees from these systems and after extensive compilation, editing has come up with “National Morbidity Codes for Ayurveda, Siddha andUnani” systems of medicine. Results: The result of this extensive exercise, National Ayurveda Morbidity Codes (NAMC) has 2971 codes classified into two main categories viz., 1. Disorders (with 20 sub-categories from A-T) and 2. natural patterns (with 3 sub-categories from U-W) ; National Siddha Morbidity Codes (NSMC) has .1623(with 29 sub categories from A-Z#) and National Unani Morbidity Codes (NUMC) has 1354 codes (1. Disorders

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(with 14 sub-categories from A-N) and 2. natural patterns (10). These standards are now available for testing purpose at the following URL: http://namstp.ayushnext.com. The same will be available on http:// namstp.ayush.gov.in after official launch. Discussion: The benefits of morbidity coding are multi-fold. Till date, due to lack of standardized nomenclatures and morbidity codes for AYUSH systems, these systems were deprived of the opportunity to show-case the services offered by them in terms of treating various morbidity conditions. Now, as the development of ASU morbidity codes has been completed and Ministry of AYUSH has prepared itself to adopt Dual Coding systems i.e. National ASU morbidity codes along with ICD-10/11, the quantification of various disorders treated by these systems has become a reality. The dedicated tool in the form of “National AYUSH Morbidity and Standardized terminologies [NAMSTP]” is going to be sun-rise platform for Medical Coding w.r.t. Indian Systems of Medicine with a judicious symbiosis with other mainstream medical coding methods.

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115 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA Documentation and Management of Electronic Health Records

Sunil B.P. MRO Trainee, [email protected] Under the guidance of A. Lakshmanan, Statistician cum demonstrator, MRD, JIPMER, Puducherry Introduction This standard sets out the requirements for documentation and management for all models of electronic health records within the public health system. Electronic Health care records promote patient safety, continuity of care across time and care settings, and support the transfer of information when the care of a patient client is transferred e.g. at clinical handover, during escalation of care for a deteriorating patient and transfer of a patient between settings. Unlike paper documents, electronic files cannot be physically held, which carries certain implications for maintaining their authenticity and security. Consequently, electronic medical records can be much more easily accessed, reproduced, and redistributed—a primary factor in the drastic increase in business data breaches during the last decade. Privacy and confidentiality All information in a patient’s electronic health record is confidential and subject to prevailing privacy laws and policies. Electronic Health records contain health information which is protected under legislation. Health care personnel should only access a health record and use or disclose information contained in the record when it is directly related to their duties and is essential for the fulfillment of those duties, or as provided for under relevant legislation. DOCUMENTATION Identification on every page a) Unique hospital number. b) A clear Patient’s full name/s. c) Date of birth (or gestational age / age if date of birth is estimated). d) Sex. The exception is Obstetrics records where sex of the mother is not recorded. Standards for documentation A good HMIS system. Legible and in English. Use approved abbreviations and symbols. Written in dark ink that is readily reproducible, legible, and difficult to erase and write over for paper based records. Time of entry (using a 24-hour clock – hh:mm). Date of entry (using dd-mm-yy or dd-mm-yy). Signed by the author, and include their printed name and designation. Entries by students involved must be cosigned by the student’s supervising clinician.

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Written in error - all errors are must be appropriately corrected. i.e. do not overwrite incorrect entries, do not use correction fluid. ICD-10 coding and Indexing of medical records Scanning of medical records Documentation by medical practitioners Medical history, evidence of physical examination. Diagnosis/es investigations, treatment, procedures and progress for each treatment episode. Where an anesthetic is administered, a record of the procedure including completion of all required procedural checklists. Comprehensive completion of all patient care forms. A copy of certificates, such as Sick and Workers Compensation Certificates, provided to patients / clients must be retained in the patient’s health care record. Documentation by nurses and midwives Care / treatment plan, including risk assessments with associated interventions. Comprehensive completion of all patient care forms. Any significant change in the patient’s status with the onset of new signs and Symptoms recorded. If a change in the patient’s status has been reported to the responsible medical practitioner documentation of the name of the medical practitioner and the date and time that the changewas reported to him / her. Documentation of medication orders received verbally, by telephone / electronic Communication including the prescriber’s name, designation and date / time. Anesthetic reports Pre-operative assessment, including patient anaesthetic history. Date and time anaesthetic commenced and completed. Anaesthesia information and management ie. medications, gases, type of anaesthetic. Operative note / monitor results. Post-operative notes / orders. Operation / procedure reports Date of operation / procedure. Pre-operative and post-operative diagnosis. Indication for operation / procedure. Procedure safety checklist. Surgical operation / procedure performed. Personnel involved in performing the operation / procedure. Outline of the method of surgery / procedure.

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Product / device inserted and batch number. Planned operation / procedure, including any adverse events that occurred. Operative / procedural findings. Tissue removed. Pathology ordered on specimens. Post-operative orders. MANAGEMENT Responsibility and accountability The Chief Executive of the Hospital must comply with the medical Records Act and its regulation in respect of health care records. Responsibility for the maintenance of appropriate health care records must be included in the terms and conditions of appointment for all health care personnel as defined in this policy. Documentation must be included as a standing item in annual performance reviews of clinicians. Failure to maintain adequate health care records will be managed in accordance with current Health policies and guidelines for managing potential misconduct. Individual health care record An individual health care record with a unique identifier (e.g. unique hospital number) must be created for each patient one number- one patient who receives health care. Every live or still born baby must be allocated a unique identifier that is different to the mother. Where multiple patient identifiers exist for the same patient / client within a PHO there must be processes established for their reconciliation and linkage, with the ability to audit those processes. Staff screening and vaccination records are considered as personnel rather than health care records and must be maintained separately. Access Health records should be available at the point of care or service delivery. Health records must not be removed from the campus unless prior arrangements have been made with the hospital eg. Required under subpoena. Health care records are only accessible to: a) Health care personnel currently providing care / treatment to the patient / client. b) Staff involved in patient safety, the investigation of complaints, audit activities or research (subject to ethics committee approval, as required). c) Electronic health record accessed by Medical record personnel only. Retention and durability Health care records must be maintained in a retrievable and readable state for their minimum required retention period. Entries should not fade, be erased or deleted over time. The use of thermal papers, which fade over time, should be restricted to those clinical documents where no other suitable paper or electronic medium is available e.g. electrocardiographs,

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Electronic records must be accessible over time, regardless of software or hardware changes, capable of being reproduced on paper where appropriate, and have regular adequate backups. Storage and security The Health Records and Information Privacy Act 2002 establish statutory requirements for the storage and security of health care records, which are also included in the Health Privacy Manual. A summary of these requirements is provided below. However, the Privacy Manual should be consulted for further detail in this area. Personal health information, including healthcare records, must have appropriate security safeguards in place to prevent unauthorized use, disclosure, loss or other misuse. For example, all records containing personal health information should be kept in lockable storage or secure access areas when not in use. As with any online digital format, concerns of breach exist. Internet hackers possess a digital power that frightens individuals looking to conceal sensitive data. There have been cases in which medical information has been accessed by unauthorized users. How to Ensure Security and Privacy ? During the transition phase, the EHR vendor must work closely with the healthcare provider for a smooth and secure transition. The company should provide some type of comprehensive user guide for the users in the provider’s practice. Enhance administrative controls Identify workstation usage Audit and monitor system users Employ device and media controls Disposal Health care records, both papers based and electronic, must be disposed of in a manner that will preserve the privacy and confidentiality of any information they contain. Disposal of data records should be done in such as way as to render them unreadable and leave them in a form from which they cannot be reconstructed in whole or in part. The disposal of health care records must be documented in the PHO’s Patient Administration System and undertaken in accordance with the relevant State General Disposal Authority. Conclusion Documentation in electronic health care records must provide an accurate description ofeach patient’s episodes of care or contact with health care personnel. The policy requires that a electronic health care record is available for every patient to assist with assessment and treatment, continuity of care, clinical handover, patient safety and clinical quality improvement, education, research, evaluation, medico-legal, funding and statutory requirements. If you haven’t already, it’s essential that your organization start tracking and managing your documents using retention schedule in order to control the growth of your record inventory. This helps establish routine policies for storing, managing, and eventually destroying your records in a timely fashion while also helping to streamline office efficiency by reducing the amount of unneeded documents taking up space

119 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA Electronic Medical Records, Healthcare, and the Patient Mrs. Soccammalle @ Manimegalai Medical Records Technician MRD, JIPMER, Puducherry

Abstract After several decades of development, Electronic Medical Records (EMRs) are now exerting a more significant impact on healthcare practices than ever before. Although most of the reasons for implementing EMRs focus on improving medical care as a whole, one must also consider the effects increased EMR use may have at the level of the patient-physician encounter. In this paper, both the advantages and disadvantages of EMR use, especially with respect to the patient-physician relationship, are examined, particularly in terms of patient trust, security of patient information, and quality of healthcare. The United States healthcare system stands on the brink of a new age of electronic health information technology. The potential for innovation within this new technology represents a great opportunity for the future of medicine. However, in seeking to implement EMRs caution must be exercised to ensure that implementation does not have adverse effects on the personal nature of the patient-physician relationship an important issue that must be addressed in order preserve the integrity of healthcare in the new electronic age. Introduction to Electronic Medical Records Electronic medical records (EMR) software is a rapidly changing and often misunderstood technology with the potential to cause great change within the medical field. Unfortunately, many healthcare providers fail to understand the complex functions of EMRs, and they rather choose to use them as a mere alternative to paper records.1 EMRs, however, have many functionalities and uses that could help to improve the patient-physician relationship and the overall quality of patient care. In order for this potential to be realized, both the patient and the healthcare provider must have a deeper understanding of EMR purpose and function. In this chapter I will provide an introduction to the modern EMR in terms of the basic definition, the historical development, relevant government legislation, and its potential effects on the patient physician relationship in order to provide an adequate backdrop for understanding many of the current problems and benefits associated with EMR implementation. Definitions: EMR VS. EHR In order to investigate the effects of electronic medical records, a definition for the electronic medical record must first be established, as the term has become increasingly ambiguous and is often confused with the electronic health record (EHR). Although many people, including those within the healthcare industry have used the terms EMR and EHR interchangeably, “these terms describe completely different concepts, both of which are crucial to the success of local, regional, and national goals to improve patient safety, improve the quality and efficiency of patient care, and reduce healthcare delivery costs. Tracing the development of emrs To understand many of the issues that physicians and patients face when encountering modern EMR systems, it is important to understand the process that has lead to the creation of many of the EMR

120 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA systems as they stand today. Beginning in the 1960s, computers were first introduced into the healthcare setting for administrative and business purposes. This was similar to many other industries that were beginning to implement computers at the time. However, it didn’t take long for people to recognize the vast potential of computers to revolutionize the way that medical information was processed. Specifically, “early work in medical informatics focused on clinical computing with a clear goal—to improve clinical decisions and reduce medical errors.” Preserving The Patient-Physician Relationship It appears that the HITECH act will be able to persuade healthcare providers to adopt EMRs at a faster rate than ever before, and healthcare providers must also be intentional about preserving the integrity of the patient-physician relationship during this transition period and beyond. When everyone is focused on the clinical or fiscal effects of EMR software implementation, it is easy to lose sight of the abstract notion of the relationship between the patient and the physician. The interaction between the patient and the physician during a clinical encounter has remained roughly the same throughout the course of modern medicine in terms of the way that information has been documented and presented to the patient. The paper record provided a concrete, confidential, and portable method of record keeping as the physician interacted with the patient, pen in hand and file in front of him EMRS From the Healthcare Provider’s Perspective In order to understand the effects of EMR use on the patient-physician relationship, I will first examine how EMR implementation may affect each entity, the healthcare provider and the patient, separately. In this chapter I will focus on the perspective of the healthcare provider. Specifically, I will discuss the effects of EMR use in terms of three areas in which EMRs have a substantial impact for the physician: cost of implementation, efficiency and workflow, and communication with the patient. Physician Communication with the Patient One of the most basic, yet most commonly neglected areas that EMRs can have an impact, is on the communication between the physician and the patient. Both at the point of encounter and afterward, the adoption of EMRs represents a considerable change in communication versus the paper record. The most obvious change presented by EMR implementation is the presence of a computer in the clinical examination room. The computer now demands a great deal of the physician’s attention, when previously the clinical encounter consisted only of the patient and the physician, with the physician perhaps jotting a few notes on the paper record. Security of EMRS and Patient Portals One of the most prevalent concerns among patients when considering the use of EMRs and patient portals is about the security of these new electronic systems.12, 13, 14, 15 As new EMRs become more widespread and increasingly networked via the internet, security and confidentiality of the information handled by the EMR software has become a greater concern than ever. The security of patient information has now shifted from being entirely controlled by the healthcare provider to a shared burdenof confidentiality among the healthcare provider, the EMR software engineers, and the patients that may now have remote access to their records. Personal health records can contain some of peoples’ most sensitive and private information. As such, any breach in the security of this information could have drastic consequences for the individual whose information has been compromised. As electronic medical records have become internet compatible through networking and patient portals, patients have become more concerned about the security of their sensitive health information.

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4.1 Advantages and Disadvantages of EMRs vs. Paper Records - Healthcare Provider’s Perspective Advantages Disadvantages Paper Cost -small up-front costs Efficiency -quick Cost -larger long-term clerical costs -greater Records and easy -familiar workflow Communication potential for billing errors -HITECH act -more freely flowing patient interview reimbursement cuts in 2015 Efficiency -more eye contact -closed patient record -must have physical record to work -higher probability of losing record -less productivity Communication -may miss important data points EMRs Cost -“meaningful use” incentives -save Cost -high up-front costs Efficiency money in clerical costs over time -more -learning period for new system/workflow accurate billing Efficiency -remote access Communication -encourages “point and click” to modify record -much lower risk of interview style -less eye contact -less patient- loss/destruction -increased productivity centered narrative Communication -reminder to gather important data -depends on communication style -patient portal and education

4.2 Advantages and Disadvantages of EMRs vs. Paper Records - Patient’s Perspective Advantages Disadvantages Paper Patient Portals -no portals, so no confusion Patient Portals -very difficult to access record Records from physician lingo Security -very secure -less physician transparency Security -less in -only one copy exists Reducing Medical office security Reducing Medical Errors -more Errors none errors -less oversight of care decisions -less information available to physician EMRs Patient Portals -easy access to provider Patient Portals -may confuse patient - problem and health info -better patient education w/ sensitive topics Security -internet access -less time wasted in the office Security to sensitive info -electronic record can be -password encrypted -no physical record accessed anywhere -patient also responsible exists Reducing Medical Errors -fewer errors for security Reducing Medical Errors none -alerts for harmful orders -better quality of care

CONCLUSION widespread implementation of electronic medical records software in the United States healthcare system has the potential to drastically alter the nature of the patient-physician relationship. Both patients and healthcare providers alike have begun to face new challenges in this age of electronic medicine, and they have also begun to reap great benefits from the advancements in health information technology. The scope and magnitude of EMR use will only increase, as government legislation calls for increased EMR use by all healthcare providers. In order to ensure the most positive outcomes, both healthcare providers and patients must be aware of the most important issues at hand when utilizing an EMR system. In the previous chapters I have discussed some of the most significant issues concerning EMR adoption versus paper record use. Specifically, I outlined the effects of those issues on the patient-physician relationship and quality of care. This analysis was performed from the perspective of the healthcare provider and from the perspective of the patient. Figures 4.1 and 4.2 provide a visual summary of the primary advantages

122 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA and disadvantages of EMRs versus paper records as stated in the previous chapters. Figure 4.1 corresponds to the healthcare provider’s perspective, and figure 4.2 corresponds to the patient’s perspective. BIBLIOGRAPHY 2010 Top 20 Best in KLAS Awards: Software & Professional Services. KLAS, 2010. http://www.klasresearch. com/Research/Segments/?id=10. American Recovery and Reinvestment Act of 2009, 2009. Baldwin, Donna M, Javán Quintela, Christine Duclos, Elizabeth W Staton, and Wilson D Pace. ‘Patient Preferences for Notification of Normal Laboratory Test Results: A Report from the ASIPS Collaborative.’ BMC Family Practice 6 (March 8, 2005): 11 Berner, Eta S., Don E. Detmer, and Donald Simborg. “Will the Wave Finally Break? A Brief View of the Adoption of Electronic Medical Records in the United States” 12, no. 1 (2005): 3–7. Committee on Quality of Health Care, and Institute of Medicine. To Err Is Human: Building a Safer Health System. Edited by Linda T Kohn, Janet M Corrigan, and Molla S Donaldson. The National Academies Press, 2000. http://www.nap.edu/openbook.php?record_id=9728 Committee on Quality of Health Care in America, Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C.: The National Academies Press, 2001. DesRoches, Catherine M., Eric G. Campbell, Sowmya R. Rao, Karen Donelan, Timothy G. Ferris, Ashish Jha, Rainu Kaushal, et al. “Electronic Health Records in Ambulatory Care — A National Survey of Physicians.” New England Journal of Medicine 359, no. 1 (July 3, 2008): 50–60. Gandhi, Tejal K., Thomas D. Sequist, Eric G. Poon, Andrew S. Karson, Harvey Murff, David G. Fairchild, Gilad J. Kuperman, and David W. Bates. “Primary Care Clinician Attitudes Towards Electronic Clinical Reminders and Clinical Practice Guidelines.” AMIA Annual Symposium Proceedings 2003 (2003): 848 O’Malley, Ann S, Genna R Cohen, and Joy M Grossman. “Electronic Medical Records and Communication with Patients and Other Clinicians: Are We Talking Less?” Issue Brief (Center for Studying Health System Change), no. 131 (April 2010): 1–

123 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA Advantages and Challenges with the Implementation of Electronic Health Record Chandra Anbazhagan, B.A., Medical Records Supervisor, MRD, JIPMER, Puducherry-6. Email: [email protected]

INTRODUCTION: Overview of the Electronic Medical Record. EHRs include electronically originated and maintained clinical health information derived from multiple sources about an individual’s health status and healthcare. An electronic health record replaces the paper based medical record as the primary source of patient information, include patient identification details, medications and prescription generation, laboratory results and in some cases all healthcare information recorded by the doctor during each visit by the patient. A Simple Electronic Medical Record System Basic Terminology The following is a list of basic terms you will need to know as you navigate the EHR market: • Electronic Medical Record (EMR) - This is an older term that is still widely used. It has typically come to mean the actual clinical functions of the software such as drug interaction checking, allergy checking, encounter documentation, and more.

Patient ID registration

Clinical Laboratory & Treatment & End Radiology Results (PD) Reports

EMR

ICD coding & Scanned Indexing Medical Records

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• Electronic Health Record (EHR) - This term refers to computer software that physicians use to track all aspects of patient care. Typically this broader term also encompasses the practice management functions of billing, scheduling, etc. • Integrated EHR - This refers to an EHR that is integrated with practice management software. Typical choices include purchasing a fully integrated product which performs all the functions of practice management software, or a stand-alone EHR which is compatible with an existing practice management system. ADVANTAGES OF EMR Potential Advantages • Better quality of care and patient safety • Cost savings and fewer workplace inefficiencies • Increased storage capabilities • Records accessible to many people at remote sites at the same time • Information retrieval is almost immediate • Record is continuously updated • Record can automatically provide medical alerts and reminders • Customized views of information for specialists • Less charting time and fewer charting errors • More accurate billing information Quality of Care Improvement • Compared to paper records, a digital patient-record (EHR) system can add information management tools to help providers provide better care by more efficiently organizing, interpreting, and reacting to data • Rapid and remote access to patient information • Computerized decision-support systems to prevent drug interactions and improve compliance with best practices. Job Satisfaction Improvement • Physician access to patient information, such as diagnoses, allergies, lab results, and medications • Improved intra-office communication • Access to patient information while on-call or at the hospital • Easier compliance with regulations • Demonstrable high-quality care • Access to new and past test results among providers in multiple care settings Customer Satisfaction Improvement • Quick access to their records • Reduced turn-around time for telephone messages and medication refills

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• A more efficient office leads to improved care access for patients • Improved continuity of care (fewer visits without the chart) • Patient access to health records, disease management tools, and health information resources for Study purpose. • Empowering the stakeholders to be able to deliver right treatment at the right time Disadvantages of EMR • High capital cost and insufficient return on investment • Lack of staff with adequate knowledge. • Confidentiality and security issues • Lack of standardized terminology, system architecture, and indexing • Lack of skilled resources for implementation and support. • Unless properly built, there’s also the chance the system will malfunction, destroy all data. Planning to rectify EMR Challenges 1. Determine the type of EMR envisaged by the institution/country 2. Identify perceived benefits of an EMR system 3. Set achievable outcome goals that will meet the needs of both users and consumers 4. Devise strategies in preparation for an EMR 5. Develop policies for use in an electronic health record system 6. Motivate the staff of medical records to improve the skill and adequate knowledge. 7. Confidentiality and Security should be made as per Authority guidance. Conclusion: I concluded that I hope the information which are given in this paper will helps to the medical Records personals and students in their professionals and suggest that the EMR system should be implemented in Hospital organization at Medical records Department.

126 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA Electronic Health Records - The 9-Step Implementation plan and Challenges for Health Centers

Mrs. Vijayalakshmi.V, BA, B.M.R.Sc., Miss. Anjana. O, Medical Records Supervisor, I-Year MBBS, Medical Records Department, Pondicherry Institute of Medical Sciences, JIPMER Hospital, Puducherry – 605014, India Puducherry – 605006, India Email id : [email protected] Ph no: 9843313348 Email : [email protected] 1. Introduction Electronic Health records is a Digital format of the medical record which will be unique for one patient throughout the world. The record will have all the personal identification details of the patient including Name, DOB, Address, Contact Phone Number, Email address, Immediate person of contact, Treatments history, Test results previously conducted, etc. Every time, when Patient visits doctor, all the visit details will be updated to the record from doctor, which both the patient and medical record department can access at any time. 2. Implementation Plan 1. Decision making is the first step as there would be so many challenges coming up with this new implementation into the organization. So the organization should first decide on acommittee members and conduct brainstorming sessions for deciding on EHR implementation. 2. Once decided, the requirements and handling of the process should be confirmed, so that accordingly HER can be implemented and synchronized well along with the patients and employees. 3. Formation of Highly skilled team for implementing the project with victory.Separate recruitment process also can be conducted. 4. A formal bid for IT companies should happen for EHR implementation. Many IT companies will be ready for implementing the same, but careful selection process needs to be executed based on cost and their previous experience. 5. Once an IT organization is selected,defined milestones has to be documented and implementation should be achieved. 6. Implementation training drills needs to be conducted to medical records department employees for better handling . 7. A sample simulation of Patients and Employees using EHR need to be scheduled for two weeks, so that both employees don’t feel any technical or process difficulties , when real time EHR is used in the organization . 8. Once it is introduced to public, start tracking of existing bugs and fix it through IT support. 9. Improve continuously by enhancing the software solution so that it is well adhered with health care organization and process.

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3. Case Study “ One Patient One Record – Similar to Seetha for Rama in Ramayana“ E-Health records are similar to Aadhar card implementation in India, Social Security Number in United States of America and similar Unique Identification System followed in different countries. It provides only one file for one person throughout the world. Wherever, a person is visiting a doctor, a hospital or clinic for any tests, the happenings will be updated to this one single record throughout the globe, which is later accessible via authorized users for that person. A Case study is conducted for EHR implementation through a IT Prototype for a smaller geographical area – Puducherry is shown below.

Fig 3.1 – IT Prototype for Puducherry EHR For every new patient created, a Unique Number is provided by the system which is of18 digits. Out of 18 digits, the first 6 digits will represent the ISD Code + Region Code used in the existing telecommunication system and remaining 12 digits will be the Unique ID like Aadhar in India, SSN in USA, etc. If required Zeros are added at the end of ISD Code + Region Code for any geographical area to make it exactly 6 digits. Similarly, if required, Zeros are added at the front of the Unique ID to make it exactly 12 digits. In our Prototype we designed the system such a way that – Person from Puducherry will get tagged as 914130+ _ _ _ _ - _ _ _ _ - _ _ _ _ ., Person from Karaikal will be tagged as 914368 + _ _ _ _ - _ _ _ _ - _ _ _ _, Person from Mahe will be tagged as 914970 + _ _ _ _ - _ _ _ _ - _ _ _ _ and Yanam will be tagged as 918840 + _ _ _ _ - _ _ _ _ - _ _ _ _. Since, Aadhar number is of 12 digits, ‘0000’s are added at the beginning of the Aadhar Card Number. So, sample Unique identification number would be like below : 914130-0000-3456-8345-0876 A card will be provided with this unique number and name printed on it for swiping to enter the health center. If in case, another record is tried to be created for same person, since we have included Aadhar card number, the system throws out error as shown below-

Fig 3.2 – IT Prototype Error

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4. Pros of EHR Implementing E-Health record to any hospital is super advantageous as it eliminates duplicate records for Single Patient and unnecessary manual efforts like - Searching medical records, Updating medical records, transferring medical records via Inter and Intra Department / hospital facilities. Apart from these, it also helps in Different categorization of Patients for analysis and research on diseases and treatments performed through time . It assists in easy accessibility of Patient Data throughout the world. Clinical reporting of Sales and Treatments can be formulated. With regard to private / autonomous organizations , Finance reporting also can be established. 5. Cons of EHR Implementing EHR is not an easy task as there would be many challenges coming up for which the organization should be ready to handle. Start up or Development cost would be tremendous, as this is a new technology that even IT needs more training and brainstorming sessions. New recruitments are required with required knowledge to handle IT people from Organization is perspective. Knowledge sessions should be done to existing naïve employees so that they are in sync with the new process. Organization wide process adaptability should be adhered so that Patient has a smooth day or smooth treatment without any conflicts due to this new implementation. Security of the Patient records are of more importance, as patient treatment history is as private as his bank statements. To maintain the security and to safe guard the same from hacking, separate security policies needs to be adapted with IT support. Backup storage at different places also should be determined, so that no patient record is lost due to any natural disasters. Conclusion Considering the opportunities and advantages of EHR implementation to the organization , facing the challenges would be worth facing. Let One Patient One Record be the new Vision statement of the organization. Like How Aadhar card is becoming like SSN, let India Health centers become UPMC of India.

129 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA 21st Century Requirements for Health Information Management (HIM) Professionals

N. Visvanathan, B.COM., B.M.R.Sc., HDC Medical Records Officer Indira Gandhi Medical College & Research Institute, Puducherry Government Of Puducherry Institution E.Mail. [email protected] Cell: 09597386017

Introduction: Health Information Management (HIM) Professionals are the most important roleplayers of the Health Sector for better patient care and supplying information, statistics to the Health Institutions and Government for the development of Health activities such as National Health Mission. We are aware Dr. G.D. Mogli is the father of Medical Records System. His experience and his written procedure manual guide lines are very useful for the implementation of Best Medical Records functioning system in India in all State Government & private hospitals and Medical colleges providing better patient care service. Dr. G.D Mogli is the first SENIOR MEDICAL RECORD OFFICER in JIPMER; Thanks to his hard work and persuasive efforts the JIPMER Medical Records Department has been serving with International standard for better patient care and has been conducting M.R.O, M.R.T courses and short term introductory classes for Doctors, Nurses and Government/Private Hospital Medical Students. Role of Health Information Management: • HIM Professionals are responsible for improving “The quality of health care by insuring that reliable information is available for making any health care decisions“ by maintaining health care data and managing information resources. • HIM Professionals are the brain of the health organizations at National and International level. For the accurate health information, health data is used by all source of personnel, such as Patients, Physicians, Paramedical persons and other allied health professional, health administrations, insurance companies, legal issues and higher authorities of Health organization and Health Ministry. • Conducting work shop / Conference and other training programs and implementation of ICD awareness programs to the Medical Records personnel which is beneficial to the hospital and National HIM development. Responsibility of Health Management Profession: • To collect, Analyze & Disseminate patient health information of the hospital for evidence based policy decisions, planning, research activities of the better patient care. • To identify & disseminate innovative practices for Health Sector development. • To develop Human resources for scientifically maintaining Medical Records in both Government & Private Medical Institution in INDIA. • To plan and produce need based IT / Trained man power for efficient implementation of health Information System.

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1. To sensitize & create a Central Pool of Master Trainers in Health Sector for Implementation of International Classification of Diseases and implement the Latest Technology of HER, EMR for better patient care. The following data shows the requirement of the Trained Manpower / it staff for Health Sector Development in the 21st century. Table: 1. Total number of medical colleges / total number of dental colleges in india with their admission capacity as in the year 2016-17.

NUMBER OF COLLEGES TOTAL NUMBER OF ADMISSION COLLEGE TYPE In India In India MEDICAL COLLEGES 462 56,748 MBBS / PG DENTAL COLLEGES BDS 309 26,790 MDS 242 6,019 ( Source : National Health Profile 2017 P252 ) Table: 2. Number of Govt. Hospitals & Beds in Rural & Urban Areas in India as on 31.12.2016.

Sl.No AREA NO. OF GOVT. HOSPITALS TOTAL NO. OF BEDS 1. RURAL 11,054 209010 2. URBAN 3,325 425869 3 TOTAL 14,379 63,4879 ( Source : National Health Profile 2017 P272 ) Table : 3. Number of Ayush Hospitals & Dispensaries in India as on 01.04.2016:

Sl. No NAME OF THE AYUSH HOSPITALS DISPENSARIES 1. AYURVEDHA 2820 15,244 2. UNANI 256 1451 3. SIDDHA 273 804 4. YOGA 7 179 5. NATUROPATHY 30 95 6. HOMOEOPATHY 203 7896 7. SOWA-RIGPA 1 33 TOTAL 2590 25732 ( Source : National Health Profile 2017 P282 )

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Table: 4. Health Infra Structure in Railways as on 27.01.2017

TOTAL NUMBER OF TOTAL NUMBER OF TOTAL NUMBER OF AREA DISPENSARIES HOSPITALS INDOOR BEDS URBAN & RURAL 580 126 13,735

( Source : National Health Profile 2017 P273 ) Table: 5. Health Infra Structure in ESI Corporation in India as on 31.03.2016

TOTAL NUMBER OF TOTAL NUMBER OF TOTAL NUMBER OF HOSPITAL DISPENSARIES HOSPITAL BEDS ESI CORPORATION 1467 151 19,463

( Source : National Health Profile 2017 P274 ) Table: 6. Total Number of Doctors, Nurses and Pharmacist Registered in India as on 2016.

ALLOPATHIC DENTAL AYUSH HIM YEAR NURSES PHARMACIST DOCTORS SUGEONS DOCTORS PROFESSION

Up to2010 8,27,006 1,14,047 - - - - Total up to 10,05,281 1,97,734 7,71,468 27,78,248 7,41,548 N A 2016 ( Source: MCI, Dental Council of India, Ministry of Ayush, INC & Pharmacy Council of India. ) National Level Man-Power Development Traning Programs. For capacity building and human resource development in Health Sector CBHI conducts in-service training programs for the staff working in various Medical Records Departments and Health Institutions of Central / State Government. Table : 7 .

SL. NO NAME OF THE TRAINING DURATION TRAINING CENTRE 1. JIPMER, Puducherry 1. MEDICAL RECORD OFFICER 1 Year 2. Safdarjung Hospital, New Delhi 1. JIPMER, Puducherry 2. MEDICAL RECORD TECHNICIAN 6 Months 2. Safdarjung Hospital, New Delhi 3. Dr. R M L Hospital, New Delhi. (Note :Training Application Forms for all the above courses can be downloaded from the CBHI official website www.cbhidghs.nic.in ) The above statements / indicators clearly show requirements of more manpower in Health Sector. In developing countries, such as India, information on human resources in the health sector is incomplete and unreliable. This comes in the way of effective workforce planning and management. The Existing Human resources facility of the Health Institutions, Colleges, Hospitals, and Dispensaries is functioning

132 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA satisfactorily for the public in India, compared with other developing countries. Table No 6 indicates the Human Resources in Health sector for Allopathic Doctors, Dental Surgeons, Ayush Doctors, Nurses and Pharmacist compulsorily registered under Separate Council of India. For HIM Professionals no such registration facility is available. For HIM Professionals data of existing Human Resources or required Human Resources are not available. This prevents effective workforce planning and Management. It can be rectified in future and given importance to register the HIM Professionals for better Health Care service. Achievements: • I, N. VISVANATHAN, am working as MEDICAL RECORD OFFICER at INDIRA GANDHI MEDICAL COLLEGE & RESEARCH INSTITUTE, Government of Puducherry Institution. • I am following the guide lines of the Dr. MOGLI Senior Consultant, eHealth Management, Health care Advisor for better patient care service. • IGMC & RI consist of 750 Bed Strength and well established Medical Records Department, Centralized Computerized Registration System and maintaining 80% Bed Occupancy • As per the ICD 10 guide lines the Coding and Indexing of discharged patients data day to day updating in the computer for quick service and better patient care, Readmission, Research , maintaining statistics, planning and Administrative purposes. • We have organized one day implementation of ICD 10 awareness program at IGMC & RI, around 350 participants benefitted, which was conducted by office of the FSU,CBHI Bangalore. Future Plan: • To introduce Electronic health Records in health care for quick on service to the patients, Physicians, Research and planning purposes. • To start the work of digitize process of patient Discharged Records shortly for safety. • To regularly conduct introductory classes of Medical Records importance for the Doctors, Medical Students, Nurses and other paramedical professionals. Conclusion: Health consciousness of the present generation and longevity of life expectancy augurs well with HIM Professionals and hence their main role is expanded to Managing Medical Records studying Health System to assist the Health IT to implement EMR, EHR for better planning and executing data collection and performing big data analytics, educating physicians and supplying Health information to Administration purpose and Health Ministry. Nurses and Pharmacists help a doctor during and after treatment for which they are trained. Similarly a HIM professional assists a doctor by initiating a patients registration, preserving the Medical Record / history and presenting the same for further reference. This may be intra – institutional and inter – institutional as well. Above statements show that data on HIM professionals are either not available or incomplete. To give impetus to this profession HR training under skill development schemes may be considered following models already available with JIPMER like star institutions. Hence, i suggest the hima to take the responsibility to propose the government to create separate council for him professionals on par with doctors, nurses and pharmacist council of india. The demand of him professionals, it staff and other technical staff is much more in our country. In our country more trained, experienced / qualified technical man power is required for him professionals for better health care career.

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BPL Telecom

“The Best Communication Solution” For Health Care

BPL Telecom Pvt Ltd, System House With Best Compliments from Palakkad, Kerala, Land Line : 0491 3017333 R. SAKTHIVEL Mobile:+91 9946036353 [email protected] Branch Manager URL: www.bpltelecom.com GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA “E-Health Record from Birth to Death globally” Better Health Information Management for Digital India” Mr. Kalleshwara. I.T. Medical Records Officer Central medical records section, AIIMS, RAIPUR

An electronic health record for every citizen of data in digital medical records: Global first e-Hospital digital medical records, the Ministry of Health & Family Welfare launched a new e-Health concept by phasing in four projects: electronic health record, digital medical records all images, digital medical records registration and digital medical records prescription. The implementation of these projects aims to create a unified national health information system linked digital medical records other public information systems and registers. The core project is the electronic health record (hereafter – e-hospital), which provides the basic integrated information technology system for all e-health solutions. By the end of 2018, the outcome of the e-hospital project will be a comprehensive central register and data-exchange of health information from birth to death for all 1.35 million Indian residents. This will be unique worldwide. in terms of information technology applications, the India health care sector is regionally and in digital medical records optionally uneven, and lags far behind progress achieved by other public services, such as state registers, taxation, e-voting etc. by 2005, most of the approximately 1200 health care services providers were already deploying an information system or using solutions developed by other providers (e.g. the health care image database created by the e-hospital universe digital medical records hospital digital medical records, e-services of the India health insurance fund, “health bank” of family doctors, etc.). At the same time, the information systems implemented by different health care providers are not mutually compatible and impede mutual information exchange. From the point of view of patients and medical professionals, the existing system of paper-based data exchange is very time-consuming and subject to problems arising from accidental destruction or loss of documents. to address this digital medical record and extend public e-services into the national health care sector, the ministry of Health & Family Welfare drafted in 2014-2015 a strategic framework for the India health care sector information system. this strategy is based on several financial and technical bid digital medical records studies of the national health care system which highlighted a significant potential for more cost-effective services through digital medical records ‘at a distance’ diagnosis and consultations of doctors and other medical services (irrespective of the location of patients or medical professionals). A targeted and efficient use of digital medical records is essential in order to meet the increasing demands of India society for a digital medical records health service. Other socio-economic objectives to provide accurate medical statistics and a cost-effective governance of national health care. Is not justalarge digital medical records project, digital medical records is a social development project involving a large partnership. Alongside implementation of new information technology concepts, digital medical records also include other aspects, such as medical standardization, ethics and legislation. To ensure effective management of the e-health project, a special implementation agency, the e-health foundation, was established in 2005. This agency is responsible for all aspects of the National Health Information System, and maintains the relevant databases and data exchange systems. The nerve centre of the e-health information system is a centrally managed electronic health record this is a centralized medical database

136 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA available on a restricted access basis to various partners: medical personnel, patients and health care author digital medical records. Digital medical records are designed to store the most important personal health data, medical records, etc. of the patient from birth to death. Stocks information which is urgently needed for the treatment of the patient, as well as information required for national and medical statistics. In add digital medical records on, digital medical records enables searching for add digital medical records information from other dispersed segments of the e-health information system (e-hospdigital medical records information systems, central system of family physicians, etc.). in terms of digital medical records- arch digital medical records, the new system will be an integrated data-exchange system based upon the already operational nationwide digital medical records-platform called x-road . During the pilot phase, performance was first assessed in three of the largest e-hosp digital medical records of India and other pilot partners joined the testing phase: air ambulance service, the family physician centers in district, and the state register of causes of death. The piloting of the integrated system started in mid- 2008 and will continue until May 2018. The project has already led to 15 follow-up in digital medical record sand projects (e.g. e-ambulance) aimed at fully deploying the results of in the period 2017-2018. From a public policy perspective, is a demanding project since the key success factors of the project are not technical or system innovations but professional consensus and public acceptance of the new form of medical data storage and exchange. The establishment of the council in 2017 should enable, e-digital medical records the proactive public information campaign, more efficient preliminary consultation and coordination of the project’s stakeholders views especially on patients’ rights and responsible digital medical records of medical professionals and other persons involved in the process of collecting, exchange and storage of private medical data. The union health and family welfare ministry will introduce a universal identification document (UID) to store electronic health data of digital medical records. On March 15, the ministry’s technical common digital medical records will open bids to appoint a firm to run the programmed, expected to be implemented in a year. The move is aimed at creating a digital medical records all profile of each patient although digital medical records will not be made mandatory to provide an Aadhaar card to get treatment in government hosp digital medical records. A patient’s health records, past ailments, allergies and diagnostic test results will be saved on the digital medical records projects like this one cannot be planned entirely in advance; they should evolve in response to scientific and medical findings. Much of the necessary methodology remains to be invented and will require the creative and energetic involvement of biologists, physicians, technology developers, data scientists, patient groups, and others. The efforts should ideally extend beyond our borders, through collaborations digital medical records related projects around the world. Worldwide interest in the digital medical records goals should motivate and attract visionary scientists from many disciplines.

137 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA Proper Documentation and Good Medical Record Keeping: An Essential Part of Patient Care.

V. Ramachandiran, MA, FHRIM (UK), Senior Medical Records Officer, Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry

Introduction In this communication, I illustrate the importance of proper case documentation and medical record keeping through a partly fictional case study as narrated below: History A 58-year-old man had attended the medical outpatient department (of a secondary care facility) with the complaint of pain abdomen on 14th July 2009. After physical examination that revealed skin petechiae, he had been admitted for further evaluation on the same day. During the ward rounds, ultrasonography of abdomen was ordered and surgical referral was also made on 15th July. He was booked for ultrasonography on 16 July. In the meanwhile, the surgeon examined the patient and advised transfer of patient to the surgical facility. On 16th July, ultrasonography of abdomen was performed and the report was sent to the medical ward. Since the patient was not in medical ward, the report was retransmitted to the medical records department (MRD). Filing clerk of MRD handed over the report to the surgical ward nurse on 18 July. The sonographic impression was cholelithiasis. The patient underwent laparoscopic cholecystectomy on 20 July. He was operated by:- Surgeon: Dr. X Assistant: Dr. Y Start time: 9.00 hrs. End time: 13.25 hrs. Postoperatively, patient developed pain and distension of abdomen, which did not resolve with support measures. Hence, patient was taken up for surgical re-exploration that revealed an injured artery during the initial surgery. Hence, Rou-en-Y procedure was performed. The post-operative period was smooth and the patient was discharged on 28 July. On 29th July, the patient’s son wrote a complaint to the Health Directorate mentioning that his father was not treated properly and also asked the reason for re-operation. Moreover, the reoperation and prolonged stay caused him mental agony and loss of wages and as such he also requested compensation. The Health Directorate forwarded the complaint to the Medico-Legal Committee (MLC) and requested the committee to investigate the case. The MLC demanded the case sheet of the patient for medical audit. From the medical record, the committee raised the following issues:- 1. Delay in referring the case to surgeon,

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2. Delay in getting the sonogram report, 3. Prolonged period of Laparoscopic cholecystectomy. Resolution: 1. The physician was called for his explanation for the delay in referring the case to surgeon, as petechia was noted during physical examination. In other words, why he did not refer the patient on the same day of admission. Moreover, the plan of care was not properly documented. As the committee was not satisfied with his explanation, he was fined. 2. The Radio-diagnosis department was questioned for the delay in issuing the report, as the impression of the sonogram report was “cholelithiasis”. The Committee felt the radiologist should have at least informed the result ( positive findings) over telephone. This would have helped the team to speed up their line of management. The Radiologist was also fined. 3. The Principal Surgeon was questioned for the prolonged period of surgery (for about 4 hours and 25 minutes). The Principal surgeon replied that he did not perform the surgery, but he assisted. His assistant willingly performed the surgery. As per the document, the principle surgeon was the operating surgeon, although in practice, it was he who assisted the surgery and the assistant actually performed the surgery. This was confirmed by the witnesses of theatre staff. The committee counseled him and imposed penalty. The Committee also interrogated the assistant (Surgeon). He replied that he had performed the laparoscopic cholecystectomy under the supervision of the unit chief. However, the committee warned him and advised him to follow the ethical norms meticulously. The committee also imposed penalty and also issued warning letters to both surgeons. The committee also paid the monetary compensation to the patient. From the above case, it is evident that proper documentation and good medical record keeping are essential part of patient care. Discussion Medical record keeping is started in India in the sixties and is grown tremendously, parallel to modern medicine: from the paper medical record, unit medical record, paperless medical record and in the recent years electronic medical record. The medical records are used for the following purposes: i. to document the course of medical illness and treatment ii. to communicate between physicians and other professionals contributing to patient care. iii. to provide continuity of patient care during the subsequent visit of the patient. iv. to review, study and evaluate patient care by hospital medical staff committees, v. to provide data to the third party concerned with the patient upon proper requisition and ensuring confidentiality vi. to provide data in protecting the legal interest of the patient, the hospital and the medical staff. vii. to provide the clinical data for research, study and education. It should be remembered that the confidentiality of the medical record is maintained, while issuing medical report either as a personal document or impersonal document. The medical record today is a compilation of pertinent facts of patient’s life and health history, including past and present illness(es) and treatment(s), written by the health professionals contributing to

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that patient’s care. The medical record must be compiled in a timely manner and should contain sufficient data to identify the patient, support the diagnosis or reason for health care encounter, justify the treatment and accurately document the results¹. In 1995, after the Hon’ble Supreme Court gave the decision that doctors also come under the purview of the Consumer Protection Act, 1986 and the medical records have become an important aspect of the written evidence. Records and documents properly kept can become defense shields for the doctors in the court of law. Hence, proper maintenance of such records should form an essential element of good practice. Therefore, the doctor should take every precaution to preserve the medical records of a patient for the stipulated period. It will act as a passport to prove his or her innocence in any alleged medical negligence². Medical records are used in medico-legal litigation to prove or disprove it. Hence, medical records are to be kept for a prescribed period, as per the retention policy of the hospital or State. The confidentiality of medical records should be maintained during the retention period. Medical records are owned by the institution or individuals providing care for the clients. Owners are responsible for safeguarding the medical record contents against loss, tampering and unauthorized access to information. Despite the medical record’s source, its purposes, contents and governing legal requirements are essentially the same. Institutional/provider responsibilities for ensuring the confidentiality of medical information contained in the medical record include avoiding unauthorized disclosure to personnel, unauthorized disclosure to outsiders, and accidental or malicious errors. The medical record is the primary source of evidence in malpractice and other professional negligence lawsuits. It is also used in criminal, personal injury, worker’s compensation, and insurance and probate cases. The hospital compiles and keeps medical records primarily for the benefit of the patient and the protection of the hospital and health care team. However, the personal data contained therein, considered as confidential communication, is the property of the patient. They are being kept for the benefit of the patient and medical records are also kept as a guide for health care professionals in the education of undergraduates and postgraduates, for the training of the nurses, medical research, for compiling statistical information and the protection of the care providers against unjust criticism. When the hospital admits a patient, it enters into an implied contract to render service necessary in the care and treatment of the patient. This necessitates keeping a chronological record of the care and treatment rendered by the medical personnel. Before a medical record may be used as evidence in litigation, the following must be established³:- i. The record is that of the patient in question, ii. the record has been compiled in the ordinary course of patient encounter and consultation iii. The record has been prepared by person who has knowledge of the events being recorded. iv. The record has been prepared before litigation begins; and v. The record is legible. Conclusion Medical records are important documents in general and more so in the event of litigation in particular. They are used in a number of ways. They are also used in legal affairs, as they provide ample healthcare information and also help in protecting the legal interests of patient and health care providers.

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Please remember that: 1. What is written and followed actually happened. 2. What is written and not followed may not have happened. 3. What is not written never happened. References 1. Huffman EK. Medical Record Management: Physicians’ Record Company, Berwyn, Illinois, 1990:p-33. 2. Jethani J. Medical Records – its importance and the Relevant Law. AECS illumination, 2004; Vol.IV, No.1: p-12. 3. Kristyn S, Appleby , Traver J. Medical Records Review. 3rd Edn. Aspen Law & Business, (1999) p-234-35.

141 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA Walking through Healthcare Stress

A Quintessential Skill to Survive the 21st Century Stress In today’s world, it is essential that everyone undergo some form of stress management training. The world itself has become a stress bomb, ready to explode any minute. Millions of people are suffering from stress related disorders like anxiety, worry, fear, depression, anger, resentment and much more. Not only does stress affect your emotional health but also your physical health. Stress is associated with the six leading causes of death – heart disease, cancer, stroke, cirrhosis, lung disease, accidents, and suicides. Often, people fall prey to addictions because of intolerable stress. That is because most people were never taught stress management skills either at school or work. Our doctors, nurses and other health professionals are no exception to the scorching effects of stress either. In fact, health professionals are under a great deal of stress these days because of increased expectations, lack of respect from patients and the society, corporate culture in medicine, new rules and regulations and much more. To practice medicine these days requires super-human patience and ever increasing dedication to the field of medicine. We as health professionals are expected to deliver at our best even under very trying circumstances. We are expected to perform at our peak under immense pressure. We are expected to keep a smile on our face all the time and act nicely as if our lives are perfect and not laden with problems. How do we live up to those expectations? How do we maintain our sanity in this insane world? How do we help ourselves not to be stressed out and do not get burnout in this process? The only true solution to all these problems is to learn to be calm in the midst of all this chaos. That is an essential skill in the 21st century for all people but even more importantly for health professionals like you. Because, once you learn to remain calm automatically you will perform better, you fill find happiness in your life, you will be a better human being and be able to help your patients and clients better. You may think, “Oh my God! How do I find calm in the midst of chaos? It sounds like a difficult task. Will I be ever able to remain calm and composed, like I always wanted to?” As a fellow health professional, I understand your concerns and worries. Many years ago, when I was under a great deal of stress, I thought that I had to live my life like that forever and there is no way out. But, at that time I accidentally stumbled upon certain principles and techniques that helped me calm down instantaneously. With that, I was able to regain control of my life and find happiness and establish a successful career. Now, I am on a mission to help fellow health professionals like you. I am here to share those principles and techniques with you and if you sincerely practice them your life will be positively transformed. “Every day you save so many lives. Don’t forget to save your own.” Take action today to learn how to handle stress, protect your health and live a peaceful and joyful life. Once you go through the stress mastery program, you will not only learn how to manage stress but more importantly how to prevent stress in the first place. Many people have used these teachings and hugely benefited from them. You can too! Wait no more. Visit www.StressFreeRevolution.com for more info. email [email protected]; Phone no. 860 375 0446.

142 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA Evaluation of Literature on Electronic Health Record System Sheetal Johar Research Scholar, CMR University, Bangalore, 9886109690 Dr Basanna Patagundi Associate professor School of management, CMRU, Bangalore Abstract Electronic Health Records have been proposed by Ministry of Health Affairs. Standards are being set and both public and private hospitals which needs to be adhered to. The purpose of this is to have complete record of the patient which includes patient demographics, physicians’ observations, test reports, medicines prescribed and any other details regarding the previous treatment so that the physician can understand the history and treat the patient accordingly, but we still find that every patient has to physically carry all the records of test reports and the history of health while visiting the physicians. Also, if the patient visits another physician there is completely no access to his/her previous EHRs. There is no interoperability in place. This paper brings out the literature review on Electronic Health Records and propose a study to understand the status of usage of EHR in Karnataka state. Introduction Health Care sector in India has witnessed significant growth during the last few years, both in quality and capacity. The relatively lower cost of health care, as compared to developed countries, along with quality, has positioned India as a major destination for health care services. The private sector also has huge investments in healthcare. The sheer size of healthcare sector in the country will necessitate extensive use of information and communication technology (ICT) infrastructure, services and databases for policy planning and implementation. Such a framework would require services based on interoperable and sharable technology, standards utilization, connecting various institutions and service providers. There will be need of international experience, best practices and open technologies in such scenarios. However, technology alone is not sufficient. There have to be standards set for data capture and maintaining the health records with privacy and security. Electronic health records can improve care by enabling functions that paper medical records cannot deliver: • EHRs can make a patient’s health information available when and where it is needed – too often care has to wait because the chart is in one place and needed in another. EHRs enable clinicians secure access to information needed to support high quality and efficient care. • EHRs can bring a patient’s total health information together to support better health care decisions, and more coordinated care. • EHRs can support better follow-up information for patients – for example, after a clinical visit or hospital stay, instructions and information for the patient can be effortlessly provided and reminders for other follow-up care can be sent easily or even automatically to the patient.

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• EHRs can improve patient and provider convenience – patients can have their prescriptions ordered and ready even before they leave the provider’s office, and insurance claims can be filed immediately from the provider’s office. MAJOR STAKEHOLDERS This list includes the following: • Citizens • Health care providers • Payers, i.e., insurance companies including TPA • Education, research institutions and investigators • Government departments and institutions including law enforcement and courts of law • Public health agencies and NGOs • Pharmaceutical industry and medical device makers • Telemedicine institutions • Software and hardware vendors 1.1 CURRENT SITUATION The current situation with respect to standards and rules set by Ministry of Health Affairs as it appears on the circular issued by them is as given here. Therefore, the standards, guidelines and regulations mentioned will apply to the following • Healthcare providers • Healthcare Institutions • Patients Independent Software Vendors including EHR/EMR System Designers, Manufacturers, Suppliers, and Re-sellers According to the “Integrated Care EHR”, as defined in ISO/DTR 20514, an “EMR is a repository of information regarding the health of a subject of care in computer-processable form that is able to be stored and transmitted securely, and is accessible by multiple authorized users”. It has a commonly agreed logical information model which is independent of EHR systems and its chief purpose is the support of continuing, efficient and quality integrated health care and it contains information which is retrospective, concurrent and prospective. The benefits that an EMR is expected to bring in are: • Paperless medical history • Reduced healthcare costs • Empowering the stakeholders to be able to deliver right treatment at the right time • Promote the practice of evidence-based medicine • Accelerate research and building effective medical practices • Usher in ease in maintaining health information of patients

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• With proper backup policies increase lifespan of health records of individuals that is from conception to cremation • safety with access, audit and authorization control mechanisms Faster search and updates In September 2013 the Ministry of Health & Family Welfare (MoH&FW) notified the Electronic Health Record (EHR) Standards for India. The set of standards given therein were chosen from the best available and used standards applicable to Electronic Health Records from around the world keeping in view their suitability and applicability in India. The Committee constituted to recommend the standards drew from experts, practitioners, government officials, technologists, and industry. The notified standards were not only supported by professional bodies, regulatory bodies, stakeholders, but various technical and social commentators as well as being a step in the right direction. MoH&FW moved ahead with facilitating the adoption, as next steps, and in last two years the Ministry has made available standards like SNOMED CT (Systemized Nomenclature of Medicine Clinical Terms )free for use in country as well as appoint interim National Release Center (NRC) to handle this clinical terminology standard that is fast gaining widespread acceptance amongst the various healthcare IT stakeholder communities worldwide. For a health record of an individual to be clinically meaningful it needs to be from conception or birth, at the very least. As one progresses through one’s life, every record of every clinical encounter represents a health-related event in one’s life. Each of these records may be insignificant or significant depending on the current problems that the person is suffering from. Thus, it becomes imperative that these records be available, arranged, and be clinically relevant to provide a summary of the various clinical events in the life of a person. Without standards, a lifelong medical record is simply not possible, as different records from different sources spread across ~80+ years potentially needs to be brought meaningfully together. To achieve this, a set of pre-defined standards for information capture, storage, retrieval, exchange, and analytics that includes images, clinical codes and data is imperative. The Govt. of India has set up standards and codes so as to bring in uniformity in maintaining these health records . This will also help in Interoperability of these records. With this facility the patient and the physician can access to the complete health records of the patient. Maintenance of medical records • Every physician shall maintain the medical records pertaining to his / her indoor patients for a period of 3 years from the date of commencement of the treatment in a standard proforma laid down by the Medical Council of India and available above. • If any request is made for medical records either by the patients / authorised attendant or legal authorities involved, the same may be duly acknowledged and documents shall be issued within the period of 72 hours. • A Registered medical practitioner shall maintain a Register of Medical Certificates giving full details of certificates issued. When issuing a medical certificate he / she shall always enter the identification marks of the patient and keep a copy of the certificate. He / She shall not omit to record the signature and/or thumb mark, address and at least one identification mark of the patient on the medical certificates or report. The medical certificate shall be prepared thereafter. 1.2 National Health Policy (NHP) 2017 After the NHP 2002, the next HHP was in 2017. The primary aim of this policy is to inform, clarify, strengthen and make the role of Government as a priority in shaping health systems. There is a need for

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organisation of healthcare services, to prevent diseases, promote good health, access to the technology, have better human resources, knowledge base, financial strategies, have more stronger regulations and health assurance. Amongst the various objectives listed in the policy, one of them is Health Management Information. The policy emphasises that at district level there should be electronic database of information on all health care systems by 2020. The Government of India wants to have Digital Health Technology. They want to encourage ehealth, mhealth etc.in healthcare which could regulate and help in having a better and continuum of care. The policy aims at involving all stake-holder of health care and to have an integrated health information system so that it would help them to serve patients better and improve efficiency, transparency and also for the citizens to have better experience. The policy also aims at providing health care at lower costs and make it affordable for all. The policy aims at linking up systems across public and private health care services at both National and state levels by maintaining certain standards for meta data and also Electronic Health Record(EHR).The policy also wants to use Aadhaar as a Unique ID for identification. 1.3 Current Health Status and Policy in Karnataka Karnataka is the Eight largest state in area(191791 sq kms), geographically , in India. The population of this state is 6.6 crore as per Census 2016. Karnataka has made a lot of progress in improving health care services over the past few years. The health care facilities would now have to gear up to use technological advancements being made in health care service system. WHO has identified six building blocks for having a strong health system. They are , health services, medicines and technologies, human resources, health financing technologies, human resources, health financing, Health Information and Governance. A systematic analysis was done to study HIS and it was found that there was (a) very less use of data for decision making. HIS ensures proper data capture, analysis and dissemination of information in a reliable and timely manner so that correct decision can be taken. The current status of HIS in Karnataka needs a lot of improvement. There is a lot of discrepancy in the kind of data available for public health managers , policy makers and researchers. The HMIS currently which is being used captures only routine monthly reporting from peripheral centres to district and national levels. Most of the data is just available on one HMIS portal and several other new programmes are not integrated to this. (b) Outmoded Information Systems: The existing staff in most of the public health sector The existing staff in most of the public health sector are over burned by maintaining multiple registers. They lack training in data collection, reporting and submission of reports for many programmes. There is lot of data redundancy. (c) Private sector Information is unavailable , although the Government has regulations and policies in place to be followed by private health care services , there is still difficulty to ascertain the number of Practitioners in private health services in state. THE CONTEXT / LITERATURE REVIEW: Critical review of about 75 research papers was carried out. A careful review of the literature was made and were classified under the following categories: • Implementation of Health Information System/Electronic Patient Record • Organisation factors in implementing EMR • Patient data privacy and security using EMR, Government policies, strategies • Comparison of use of EHR in public and private hospitals in Trinidad and Tobago

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• A few of the key literature reviewed is summarized below: Almutairi B(2011) in his study identifies the benefits of using EHR and its barriers to successful adoption. This research examined the adoption of EHR in primary health care in Kuwait and proposed a roadmap to implement it which included the policy makers, decision makers and end user. Study was conducted at each level The benefits of EHR systems are clear, as a report from the Congress of the United States (2008: p.6) indicates, “no aspect of health IT entails as much uncertainty as the magnitude of its potential benefits”. The benefits of an EHR are affected directly and indirectly by how individuals use the system – health professionals‟ are particularly positive about EHR systems if they understand that it is a tool to improve patients‟ health and the quality of services, rather than concerned with budget savings and government efficiencies. The researcher proposes future research to elicit the perspectives of stakeholders in secondary and tertiary health care levels. Also comparative studies could be carried between Kuwait and other Gulf countries. The study conducted by Maria Cucciniello (2011) aimed at making an in depth investigation to evaluate the effects of Electronic Medical Record system by comparing the two study settings which implemented the same EMR system produced by the same provider. Key issues arising at these to hospitals were studied. Analysis, interviews and observations were carried out. This study offered to practitioners, policy makers a better basis of analysing ICT(Information and Communication Technologies) usage and its impact on health care service delivery. The project aims to make a theoretical and methodological contribution to the evaluation of EMR impacts on the organization and to produce advice forpublic decision making processes. Viginia, Craig, Mihir and James Courtney(May 2009) in their study examined the physicians’ response to the electronic medical records(EMRs). The physical accessibility and the logical feasibility of use of EMRs was studied. They found many a times the physicians did not have the physical access to the EMRs and many a times they had access but felt it is better to spend more time on the patient rather than update the data in EMR. This study found mainly accessibility , be it physical or logical to be the mains barriers and had indirect effect on physicians’ perceptions of EMR usefulness and ease of use. Archer Fevrierr-Thomas, Lokker and others (2011) in their study on Electronic Personal Health Record(PHR) found that primary care physicians play a key role in PHR as these are linked to the EMR maintained by the physicians. The PHRs do not include any patient functionalities. It is all dependent on how the physicians use it and update the patient records. The EMR are maintained by physicians as per their need and it may not necessarily be useful for patients. The PHR is what a patient can use to get information. Although only some category of people are likely to adopt to PHR, care has to be taken by developers to make it more accessible and encouraging so that more people can use it. They found very little solid evidence from other studies about effectiveness in improved patient health outcomes through the use of PHRs. They felt more research is needed that addresses the lack of understanding of optimal functionality and usability of these systems, and how they can play a beneficial role in supporting self- managed healthcare. Freda Mold, Simon de Lusignan, Aziz Sheikh, Azeem Majeed and others(March 2015) in their study found patients satisfaction in accessing their electronic health records online. This gave better patient physician relationship and communication. But there was also a concern about the usage of online services by people from the lower economic strata. On the other end the physicians felt whether all this is going to increase their work load. But post intervention this was unrealised. The nature of the medical record and the role of the clinician may need to evolve to give greater value to patients and to ensure greater equity in uptake. They also found a better business model to be developed for better utilisation of information technology in everyday practice. Kathrin M.Cresswell (2012) studied about the consequences faced by users of new technology involving electronic health record. Due to the complex processes involved in implementing and adopting

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new technology there were changes in organisational functioning and work practices. She took up this study in English health care setting about national implementation of electronic health records and one of the procured systems was Lorenzo. She conceptualised her study in form of case studies. She applied a theoretical framework to explore sociotechnical processes involved in the implementation and adoption of Lorenzo. It was found that most importantly, national implementations need to build on a solid basis of local technology adoption by allocating sufficient time for individual users and organisations to adjust to the complex changes that often accompany such service redesign initiatives. Gin Gregory et.al(2011) in their study examined the relationship between financial position and adoption of EHRs. They found that adoption of HER was more of a strategic decision rather than a financial decision. For smaller hospitals the capital outlay was much higher when compared to the returns whereas for larger hospitals with large number of patients the outcome was better. Each hospital would have to make a strategic decision in this regard. Kersten Sandra(2013), found in the study that EHR had progressed from implementation to optimization and that provider organisations had begun to realise the benefits of this technology . It was found that an information governance program was critical for maximising the EHR and other information systems to get accurate and actionable data that can help organistion achieve improvements in care and costs. Sabnis and Charles(2012) in their study found that since there is extensive information sharing by electronic means and also that the information is sensitive , there are issues of integrity, privacy and confidentiality. Technology and service providers together with the stakeholders of healthcare should develop universal standards for interoperability. Love, Varick(2011) in his study brought out the analysis of confidentiality , integrity and availability criteria for successful IT security strategy in U.S healthcare. Confidentiality is to prevent the unauthorised disclosure of patients’ EHR. Healthcare organisations must understand the risks involved if the patient records are not secured. He also found that there is a need to create security strategy based on the rules. They must adhere to the rules that are written down and only then can the patient records that are being protected by healthcare organisation be truly secured. Clarke and others(2009) in their study examined the emerging use of EHRs , practices, problems and also how to mitigate customer risks. They felt that there was a need to look into as to what information of the patient had to be maintained and for how long. If the patient moves out to another location or health care provider, then should the hospital still maintain those records and for how long. There was a need for complete security and privacy of patient records. Latha, Anju(2015) in her study discusses about the benefits of EHR and the barriers in its successful implementation in India. Some of them being cost, leadership, vendors keeping up user needs, deficits in public policy. The study focused more on Integrated Electronic Health Record System (IEHRS) research and implementation of it for maintenance of health report using Health smartcard. This could reduce medical errors , improve patient care and provide link to medical knowledge and clinical decision support systems. It would store basic biomedical prameters like glucose oxymeterr, pulse oxymeter which can be transferred to personal computer and then stored in health care. Mohamud, Koshin(2015) in his study wanted to identify the core EHR functionalities available to physicians who work in public and private health care facilities and the extent to which the physicians are using the functions and also to understand the rate of adoption of EHRs in public and private hospitals. There was a large gap between the two groups in Result Management, Order Management and Decision Support functions. He found higher EHR adoption rate among private physicians when compared with public physicians(25% vs 11%). The barriers for adopting EHRs was found to be start-up cost(38% vs 47%)

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(private vs public). Outside stakeholders also had a role to play but less with private physicians and more with public hospital physicians to adopt to EHR decision making. The summary of type of literature review done is as follows:

No. of No. of disser- Category of literature Relevance to the study articles from Total tations journals

Implementation of Health Benefits, challenges , Information System/ obstacles during the 27 07 34 Electronic Patient Record process of implementation The doctors and staff Organisation factors in involvement, infrastructure, 22 03 25 implementing EMR organisation support during and post implementation Security measures taken Patient data privacy to gain the patient’s and security using EMR, confidence, govt. policies, 10 04 14 Government policies, strategies to have strategies uniformity in EMR leading to complete usage of EMR Comparison of use of EHR in Directly linked to the theme public and private hospitals 01 01 02 of the proposed research in Trinidad and Tobago TOTAL 60 15 75

Table 1: Summary & Classification of Literature Review Conclusion The review of literature indicated that the research on EHR is focussing on developed countries like Unites States, Australia, United Kingdom, other parts of Europe and some parts of UAE. Limited literature was found on the study of Health Record Management System in India. The review showed the benefits of using Electronic Health Records, such as it is more accurate, reliable , lesser errors while maintaining patient records, standardisation of processes, the ease and agility in recovery of information, better control over prescriptions, better adherence to protocols and standards established by the hospitals. The review also brought out the challenges faced in implementation of EHRs which included lack of proper training for staff to use EHRs, absence of proper policies, guidelines and standards. There has also been studies with respect to the security and confidentiality of patient records. There was a study found on comparision of use of EHR functions by physicians in Trinidad and Tobago’s private and public care facilities. However, a comparative study of public and private hospitals in India with respect to EHR functioning was not found and hence I am pursuing with the study. Electronic Health Records have been proposed by Ministry of Health Affairs, standards are being set and both public and private hospitals have to implement these. The purpose of this is to have complete record of the patient which includes patient demographics, physicians’ observations, test reports, medicines prescribed and any other details regarding the previous treatment so that the physician can understand the history and treat the patient accordingly, but we still find that every patient has to physically carry all the records of test reports and the history of health while visiting the physicians. Also, if the patient visits another physician there is completely no access to his/

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her previous EHRs. There is no interoperability in place. So, to understand where the problem lies, is it in the software developed by vendors or is it the patient not permitting to store their records or is it that the physicians’ unwillingness to record the treatments. References: Almutairi B,A strategic roadmap for achieving the potential benefits of electronic health record system in State of Kuwait(2011) retrieved from http://discovery.ucl.ac.uk/1332883/1/1332883.pdf Circular on Electronic Health Record by Ministry of Health and Family Welfare http://mohfw.nic.in/showfile. php?lid=1671 Clarke, Irvine; Flaherty, Theresa; Hollis, Stacy; Tomallo, Mak- Academy of Healthcare Management Journal, 2009, Vol 5, Issue ½, p63-77. Electronic Health Record Standards for India , NHP,http://www.nhp.gov.in/ehr-standards Freda Mold, Simon de Lusignan, Aziz Sheikh, Azeem Majeed, Jeremy C Wyatt and others ,Patients’ online access to their electronic health records and linked online services: a systematic review in primary care , British Journal of General Practice, March 2015, pg 141-151. Gin Gregory,Shen Jay,Mosely Charles, Hospital Fianancial position and the adoption of Electronic Health Records, Journal of Healthcare Management, Sept/Oct 2011, vol 56, Issue 5, p 337-350. Kathrin M.Cresswell ,Implementation and adoption of the first national electronic health record : a qualitative exploration of the perspectives of key stakeholders in selected English care settings drawing on sociotechnical principles, Retrieved from https://www.era.lib.ed.ac.uk/handle/1842/6519 Kersten Sandra,Moving the needle toward a Data driven Health Care System : Optimising the EHR through Information Governance, Journal of Health Care Compliance , Maay-June 201, Vol 15, Issue 3, p 45-62. Latha, Anju; Integrated Electronic Health record System , Retrieved from Sodhganga @ Inflibnet, http://hdl.handle. net/10603/62957 Love, Varick; IT security strategy : Is your Health Care Organisation Doing Everything It can to Protect Patient Information ? , Journal of Health Care Compliance, Nov/Dec 2011, Vol 13, Issue 6, p21-29. Maria Cucciniello ,Investigation of the use of ICT in the modernization of the health care sector : acomparative analysis(2011) Retrieved from http://uk.sitestat.com/bl/ethos/ /hdl.handle.net/1842/8733 McLean, C., Hassard, J. (2004) Symmetrical Absence/Symmetrical Absurdity: Critical Notes on the Production of Actor- Network Accounts. Journal of Management Studies, University Press, Oxford. Volume 41, Issue 3, pages 493– 519, May 2004. Mohamud, Koshin; Electronic Health Records in Trinidad and Tobago(2014), Thesis retrieved from https://pqdtopen. proquest.com/pubnum/3739555.html?FMT=AI on 15/10/2017 N Archer, U Fevrier-Thomas, C Lokker, K A McKibbon, S E Straus ,“Personal health records: a scoping review” Jamia Oxford Medical Infom Assoc, 2011 Volume 18, page , 515-522 Law, J., (1991) Introduction: monsters, machines and sociotechnical relations. In: Law, J. (Ed.), Sociology of Monsters: Essays on Power, Technology and Domination. Routledge, London, pp. 1–23 Sabnis,Suhasini;Charles,Doug; Opportunities and Challenges: Security in eHealth , Bell Laba Technical Journal, Dec 2012, Vol 17, Issue 3, p 105-111. Viginia Ilie, Craig Van Slyke, Mihir Parikh, James Courtney ,Paper versus Electronic Medical Records: The Effects of Access on Physicians’Decisions to Use Complex Information Technologies , Decision Sciences Journal, Volume 40 Number 2 , May 2009 https://www.nhp.gov.in/health-policies_pg http://www.karnataka.gov.in/hfw/kannada/Documents/Karnataka_Integrated_Public_Health_Policy_2017.PDF

150 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA “Checklist Manifesto- Using clinical protocols integrated with Electronic medical records to standardize primary care and ensure quality by Apollo clinics” Dr. Sachin Ganorkar, Medical Superintendent, Apollo Clinics, India, 9322670885 Problem Statement – Standardizing clinical protocols at the point of care helps ensure good quality early diagnosis in an outpatient set up , appropriate investigations and rational drug therapy. It is challenge to standardize care delivered at multiple outpatient locations at the point of care by healthcare providers and ensure quality. In addition, acknowledging that there may be gaps in physician clinical competence, there is a need to ensure that their skills are updated to reach the standards required by Apollo. Approach – Apollo clinics have integrated common outpatient conditions like hypertension, fever in India within their Electronic Medical Record as templates for early diagnosis, lab investigations and rational drug therapy which helps the physician refer as a checklist to deliver standard care across their center based on standard clinical guidelines contextualized to Indian conditions. It also helps guide the patient to a higher center in case symptoms are red flagged to indicate tertiary referral thereby closing the care loop. The patient records are available in the Electronic Medical Record view to be audited and for continuity of care- care which is important for non- communicable, chronic diseases and act as a condition management follow up template view. The data is also available to be analyzed for community trends in disease presentation. As a fallout-investigations may be prescribed that can be rationally justified, help in early diagnosis and increase the business for the diagnostics Services at the center. In addition, this is being integrated with patient education material that is customized to their condition to help educate patients better about their conditions and promote pre-emption of secondary complications. Methods - 1. Latest clinical guidelines for 28 common Outpatient symptoms were integrated in the form of templates for the physician to use as a checklist at the point of care. These include the options that are required according to algorithms for clinical decision making-for clinical history, examination, red flags, differential diagnosis, investigations and treatment 2. Training and sensitization was carried out for the family physicians and clinic teams to start using the system. 3. End User adoption is being reviewed and encouraged by providing convenient hardware solutions at patient encounter points; having automatic monitoring systems and following up on a regular basis. 4. The protocols will be upgraded over a period of time as per the peer feedback received from physicians to make it a continuous process based of recent updates. Process and Outcomes expected - The workflow is aligned in the clinics such that the patient visits the family physician at the first point of contact to get reviewed under a protocol. As next steps-there will be an audit of compliance to adoption, the outcomes of the protocols will be audited for reductions in patient complications and patient satisfaction because of compassionate, quality care, thepatient education delivered and availability of meaningful data. Key Words – Clinical Protocols, First point of contact , Point of care, Standardization, Early Diagnosis, Appropriate investigations, Rational therapy, Pre-empting complications, Red flags, End user adoption , Audit.

151 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA Life Health Record ­K.S.Murugapiran B.A., BRMSc., Senior Medical Record Officer MAPIMS, Melmaruvathur, Kanchipuram district, Tamil nadu, Pin code: 603 319

The WHO defines health as a state of physical , mental , social well being not merely an absence of diseases or infirmity. Really speaking heath is not a state but continues adjustment to the changing demands of life and environment Till now strangely only Allopathic medicine was considered ‘Scientific’ and other indigenous systems , though based on empirical knowledge were labeled ‘Quackery’ . Ideas have changed, Interest in alternative medicines and medical care system is growing in the West. Ayurveda is being studied deeply. Homoeopathy is already being practiced even by Allopathic doctors. Psychotherapy hypnotism, Yoga therapy, Yogic pranayama and Asanas etc., are vying for there own place Health for all Health cards for all the children born should be given and that card should be utilized till he/she attains the age of 12 In the case of adult also it is envisaged, because the recordings of medical examination given at one time or other would nullify the present illness. It is a drive to achieve Health for All proposed earlier in 2000 AD Hospital can store IP/OP records in Unit Numbering system. It will facilitate the patient/physician/ hospital in a larger way. The lacunae is the attendance of the patient at a later date, he may opt for a change in the treatment at another hospital. However, the hospital which he/she has chosen for a change should maintain the same type of Unit IP records. Educating the Public Very often some people come to the hospital without any records of previous treatment, if any. Rural folk does not reveal their previous admissions for fear or bring the old records unknowingly of it’s value. If enquired, house burning, flood, cyclone, loss of bag in the buss together with money are their pocket full excuses. MRD staff help these cases by verifying either alpha index cards, or OP/IP nominal registers. Hospital having facilities for storing OP records find it easy for their speedy consultations. There cannot be any change in the face of Indian Health unless/until the consumer/citizens of the service also get much more committed. Importance felt by the Urban mass In Chennai­­ 75% of the people are aware of the importance of keeping the records in their possession. The reason is to curtail expenditure on Tests/examination and also for quicker treatment. Very often patients are questioned by the doctors/MRD staff about the previous visits, if any of the patients. Thus awareness has been felt and they act accordingly. People attending the hospital also comes to know about the MRD and its staff handling the records

152 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA in a systemic way. Psychologically an inward desire arises to keep the records given to them at the time of discharge. This development should not halt at the Urban areas only. Rural hospitals should also take all steps to take off their consumers/citizens to the city level. National or world wide participation of medical record personal would bring about greater and more rapid advances in the establishment of international standards, het­ compilation of statistics that could be used for national/international comparisons To create awareness in keeping the hospital records of treatment on a greater scale a 1 or 3 minute visual communication could be arranged through television by the Health departments of the centre/ state. Congenital Malformation and deformities are determined through USG during gestation. Mothers are informed about the development of the child inside the womb. During Perinatal period and after some of the children may be affected by congenital problems such as congenital heart disease(CHD), Patent ductus or arteriosus and other problems. They are detected, corrections made either conservatively or thro’ surgery. Treatment of these cases during the child hood period are essentially required for reference and clinical management at adolescence period. Thus case records from the birth finds a place of its own and preservation of the same is inevitable. Patients medical treatment can be stored in a system and retrieve the same at a later date, and at different place. This will substantiate loss and misplacement of records Hence, The importance arises to keep hospital treatment records from the child to adult for the following reasons Up keep of Health in a better way To cut down expenditure and save time Help the doctors, hospital and particularly patients very much Thanking you References : Healthy Mind, Healthy Body by Swami Gautamananda.

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154 JIPMER HIMA ASIA CONFERENCE - 2017 SUBRAMANIA BHARATHI HR. SEC. SCHOOL THIRUKKANUR – PUDUCHERRY – 605 501 PHONE: 0413-2688930, 2688931 BHARATHI ENGLISH HIGH SCHOOL SORAPET– PUDUCHERRY – 605 501 PHONE: 0413-2688932 30 years experienced Educational Institutions.

 Tamil, English, Hindi & French (4 languages)  Additional classes for Abacus, Smart Class, Spoken English & Robotics  Extra curricular activities - Bharatham, Karate, Yoga, Music, Key Board, Western Dance, Arts & Craft and Scout.  NEET Class for Higher Secondary Students.

Achievements:  All the Years we stood up Centum result in SSLC - State level Rank & “12 C.M. Award” For SSLC Centum Result  Every year got highest mark in HSC.  Most of the Educational Awards received from the varies institutions. GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA

Invited Hon’ble Lt. Governor of Puducherry for the JIPMER HIMA Asia Conference 2017

Releasing of Brochure for JIPMER HIMA Asia Conference 2017

Invited Hon’ble Chief Minister, Puducherry for the JIPMER HIMA Asia Conference 2017

Invited Hon’ble Health Minister, Puducherry for the JIPMER HIMA Asia Conference 2017

Initiation of JIPMER HIMA Asia Conference by Dr. G.D. Moghli

Cash Prize for Designing Souvenir Cover Page to Yuvaraj

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159 JIPMER HIMA ASIA CONFERENCE - 2017

GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA Email. ID [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] Mobile Number 9942171456 9462373967 9686794271 9686794271 9686794271 9972882868 9495493082 9847907882 9791548475 7639748979 9626110903 9443128373 9626201199 9489967366 9843313348 Name of Institute GOVT. THENI MEDICAL COLLEGE, THENI, GOVT. TAMILNADU. BORDER SECURITY FORCE CHITRADURGA, SRIDEVI HOSPITAL, KARNATAKA CHITRADURGA, SRIDEVI HOSPITAL, KARNATAKA SRIDEVI MEDICAL COLLEGE, CHITRADURGA, KARNATAKA. , HOSPTIAL, CHITRADURGA VIJAYANAGARAJ KARANATAKA MEDICAL COLLEGE, GANDHI GOVT. INDIRA KERALA.TRIVENDRAM, MEDICAL COLLEGE, GOVT. KERALA THIRUVAANTHAPURAM, MEDICAL COLLEGE & AARUPADAIVEEDU PUDUCHERRY HOSPITAL, MEDICAL COLLEGE & AARUPADAIVEEDU PUDUCHERRY HOSPITAL, MEDICAL COLLEGE & AARUPADAIVEEDU PUDUCHERRY HOSPITAL, MEDICAL COLLEGE & AARUPADAIVEEDU PUDUCHERRY HOSPITAL, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, DESIGNATION HOSPITAL WORKER HOSPITAL HC/NA MEDICAL RECORDS TECHNICIAN MEDICAL RECORDS TECHNICIAN MEDICAL RECORDS TECHNICIAN MEDICAL RECORDS TECHNICIAN ASSISTANT LIBRARY GR.I MEDICAL RECORD LIBRARIAN M.R.O. ENTRY OPERATOR DATA JUNIOR ASSISTANT ASSISTANT STATISTICIAN-CUM- DEMONSTRATOR MRS MRS PARTICIPANTS : JIPMER HIMA ASIA CONFERENCE-2017 PARTICIPANTS NAME MR.S. SARAVANA KUMAR SARAVANA MR.S. MAHAJAN PANDURANG MR. V.R MISS.SWETA V.R. MR.ARUN N.T. MR.NAVIN MR.KIRAN.T SUNILKUMAR MR.M. K.S. MR.SHIBI ILAMPOORANAN MR.S. MS. J. JAYAVATHI RENUGADEVI MRS.P. MRS.N. LAKSHMI MR.A. LAKSHMANAN MRS.CHANDRA ANBAZHAGAN VIJAYALAKSHMI MRS.V. SL. NO. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

161 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] 8870792384 9159550528 9488074455 8940022273 9789557535 9994342090 9047445938 8940073403 9940928675 9487982901 9360779063 8870175744 9787066017 9791855105 9677973259 9894847962 9787057066 9994078560 9842322335 9443768439 9566966324 9092331333 9943799565 9976619650 8608962724 9787432105 9578502905 JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, MEDICAL COLLEGE SRI VENKATESWARA CENTRE, ARIYUR, & RESEARCH HOSPITAL PONDY THENI MEDICAL COLLEGE HOSPITAL, GOVT. THENI, TN MEDICAL RECORDS TECHNICIAN MTS MEDICAL RECORDS TECHNICIAN MEDICAL RECORDS TECHNICIAN MEDICAL RECORDS TECHNICIAN MEDICAL RECORDS TECHNICIAN MEDICAL RECORDS TECHNICIAN MEDICAL RECORDS TECHNICIAN MEDICAL RECORDS TECHNICIAN MEDICAL RECORDS TECHNICIAN MEDICAL RECORDS TECHNICIAN MEDICAL RECORDS TECHNICIAN MEDICAL RECORDS CLERK MEDICAL RECORDS CLERK MEDICAL RECORDS CLERK MEDICAL RECORDS CLERK MEDICAL RECORDS TECHNICIAN MEDICAL RECORDS CLERK MEDICAL RECORDS CLERK MEDICAL RECORDS CLERK MEDICAL RECORDS CLERK MEDICAL RECORDS CLERK LDC TRAINEE TRAINEE M.R.T. JIPMER M.R.T.STUDENT, MR.G.RAVICHANDRAN N. MOUTHOUKRISHNASWAMY MR. MEIGANDAN MR.N. DEVIPRIYA MRS.P. NARAYANAKUMAR MR.S. MURUGAIYAN MR.S. MRS.N. BOUVANESWARI MR.A. MARTIN MR.SIVAGOUROUNADIN MR.P.SANTHANAM MR.SHANMUGARAJARAJAN SIVACOUMAR MR.S. VIRABHAGU MR.P. DJEARAMANE MR.P. MR.A. SANNIYASI MR.S.THILLAIAMBALAVANAN SELVARASU MR.B. NARAYANANE MR.K. PALANI MR.S. DANARADJOU MR.G. MADHAN MR.M. KAVITHA MRS.P. S KUMAR. MR.BIJU RAKESH MR.R. MRS.K. MEENAKSHI R KUMAR. MR.ASHOK MR.D.RAJAMOHAN 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42

162 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected]

8124625124 7845574040 9745970147 9037855490 9349466743 9840548743 9042630611 9940982616 9940743512 9676008858 9842634323 8428324363 8870214583 9486250171 8257977242 9495109490 9847219411 9946327516 9840375915 GOVT. THENI MEDICAL COLLEGE HOSPITAL, THENI MEDICAL COLLEGE HOSPITAL, GOVT. THENI, TN THENI MEDICAL COLLEGE HOSPITAL, GOVT. THENI, TN GOVT MEDICAL COLLEGE ,KOTTAYAM,KERALA GOVT MEDICAL COLLEGE ,THIRUVANANTHAPURAM,KERALA GOVT MEDICAL COLLEGE,KOZHIKODE,KERALA MEDICAL COLLEGE GOVT STANLEY HOSPITAL,CHENNAI GOVT MEDICAL COLLEGE HOSPITAL,COIMBATORE MAARUTHI MEDICAL CENTRE AND HOSPITAL,ERODE GOVT MEDICAL COLLEGE HOSPITAL,COIMBATORE RIMS GENERAL HOSPITAL,KADAPA,ANDRAPRADEESH MEDICAL GOVT MOHAN KUMARAMANGALAM COLLEGE HOSPITAL,SALEM MEDICAL GOVT MOHAN KUMARAMANGALAM COLLEGE HOSPITAL,SALEM BSF HOSPITAL,CHATISHGARH MEDICAL COLLEGE TIRUNELVELI HOSPITAL,TIRUNELVELI SERVICES OF HEALTH DIRECTORATE ,AIZAWL,MIZORAM GOVT MEDICAL COLLEGE ,KOTTAYAM,KERALA GOVT MEDICAL COLLEGE ,KOTTAYAM,KERALA GOVT MEDICAL COLLEGE ,KOTTAYAM,KERALA HOSPITAL,AVADI,CHENNAI GOVT TALUK M.R.T. STUDENT, JIPMER STUDENT, M.R.T. JIPMER STUDENT, M.R.T. JIPMER STUDENT, M.R.T. JIPMER STUDENT, M.R.T. JIPMER STUDENT, M.R.T. JIPMER M.R.T.STUDENT, JIPMER STUDENT, M.R.T. JIPMER STUDENT, M.R.T. JIPMER STUDENT, M.R.T. JIPMER STUDENT, M.R.T. JIPMER STUDENT, M.R.T. JIPMER STUDENT, M.R.T. JIPMER STUDENT, M.R.T. JIPMER STUDENT, M.R.T. JIPMER STUDENT, M.R.T. JIPMER STUDENT, M.R.T. JIPMER STUDENT, M.R.T. JIPMER STUDENT, M.R.T. JIPMER STUDENT, M.R.T. MR.S. SHANMUGAMANI MR.S. MR.S.RAJKUMAR MR.P.K.BIJU MR.KRISHNAKUMAR.V NAIR.K MR.SIVADASAN MR.S.SHANMUGAM MR.V.SIVANESWARAN MR.A.G.SASIKUMAR MRS.M.DEVIKA BABU MR.K.JAGADEESH MR.A.SELVAKUMAR MR.M.BALAMURUGAN MR.T.K.KULASEKARAN MR.P.SUDALAI MS.LALLAWMZUALI PC AUGUSTINE MR.THOMAS MR.SUNILKUMAR.R .D.S MR.PRINCE MR.B.KRISHNAN 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61

163 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected]

9843732480 9847841984 9965175175 8011916839 9994182336 8768730327 8604528519 8870280190 9700139392 9789397816 9164726237 9790359971 9442122577 9442287159 9488074455 9442122577 9894678800 9566069002 9159607454 9446026395 9446068281 9497000230 9447517934 9961104024 9790467925 JIPMER, PUDUCHERRY JIPMER, GOVT MEDICAL COLLEGE,KOZHIKODE,KERALA GEM HOSPITAL,COIMBATORE 43 BN/BSF,ROSHANBAGH PUDUCHERRY JIPMER, 39 BN/BSF,ROSHANBAGH CAREER MEDICAL LKO PRADESH UTTAR COLLEGE HOSPITAL,THENI NRT MGM HOSPITAL,WARANGAL,TELANGANA PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, IGMRI, PUDUCHERRY PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, MEDICAL COLLEGE, GOVT. KERALA THIRUVAANTHAPURAM, KERALA COLLEGE, KOTAYAM, DENTAL GOVT. MEDICAL COLLEGE, GOVT. KERALA THIRUVAANTHAPURAM, KERALA COLLEGE, KOTAYAM, DENTAL GOVT. MEDICAL COLLEGE, GOVT. KERALA THIRUVAANTHAPURAM, PUDUCHERRY SMVMCH, MADAGADIPET, M.R.C. M.R.T. STUDENT, JIPMER STUDENT, M.R.T. JIPMER STUDENT, M.R.T. JIPMER STUDENT, M.R.T. M.RC. JIPMER STUDENT, M.R.T. JIPMER STUDENT, M.R.O. JIPMER STUDENT, M.R.O. JIPMER STUDENT, M.R.O. M.R.C. STUDENT M.R.T. M.R.T. M.R.T. M.R.T. M.S. (ENT) M.B.B.S. (Student) M.R.C. M.R.T. M.R.T. ASSITANT JUNIOR LABORATORY ASSITANT JUNIOR LABORATORY GR.I MEDICAL RECORD LIBRARIAN ASSISTANT LIBRARY MEDICAL RECORD LIBRARIAN M.R.T. MRS.RAMANICAROUNAGARANI MR.RENUKA K.K MR.RENUKA MRS.M.ANBARASI MR.DHRUBAINARAYAN BORDEURI MR.V.MURUGAIYAN MR.A.KASI SHAZMAN MR.MOHAMMAD MR.S.KANTHAVEL MR.VANGARAVINDER MRS.S.SARASVADY B.P MR.SUNIL MOORTHY MR.R. MRS.M. INDOUMADY MRS.S. SOCCAMMALLE @ MANIMEGALAI SUBHASHINI P.R. DR. MS.M. KIRUTHIKA MOUNISSAMYMR.S. SAKTHIVEL MR.S. MRS.J. SELVI SREEKUMAR.A MR. K.B. VIJAYAKUMAR MR. N.S. MRS. SYMAKUMARI REJIKUMAR MR. UNNI. S MR. SIVAGURU MR. 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86

164 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] 9790426777 9843357462 9600830386 9443005545 8870831584 9585976739 9042151077 9943937658 9495124242 9585978644 9597386017 9488814031 9842324597 9789620580 9626043982 9629881792 9943701301 8110895108 8524953245 8056665250 9047539234 8599009249 9942784473 9791852418 9843826394 8608710414

MEENAKSHI HOSPITAL, THANJAVUR MEENAKSHI HOSPITAL, IGGGH&PGI, PUDUCHERRY SMVMCH, MADAGADIPET, PUDUCHERRY SMVMCH, MADAGADIPET, IGGGH&PGI, PUDUCHERRY IGGGH&PGI, PUDUCHERRY IGGGH&PGI, PUDUCHERRY RGGWCH, PUDUCHERRY RGGWCH, PUDUCHERRY THIRUVANANTHAPURAM, HOPITAL, S.A.T. KERALA. SLIMS, PUDUCHERRY CHENNAI, HOSPITAL, GANDHI GOVT. RAJEEVE TN. IGMC & RI, PUDUCHERRY IGMC & RI, PUDUCHERRY IGMC & RI, PUDUCHERRY IGMC & RI, PUDUCHERRY IGMC & RI, PUDUCHERRY IGMC & RI, PUDUCHERRY SLIMS, PUDUCHERRY SLIMS, PUDUCHERRY SLIMS, PUDUCHERRY THANJAVUR MEENAKSHI HOSPITAL, THANJAVUR MEENAKSHI HOSPITAL, THANJAVUR MEENAKSHI HOSPITAL, THANJAVUR MEENAKSHI HOSPITAL, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, MEDICAL RECORD TECHNICIAN ASSISTANT MEDICAL RECORD ASSISTANT OFFICER M.R.T. M.R.T. M.R.T. M.R.T. MEDICAL ATTENDER MEDICAL RECORD LIBRARIAN M.R.C. NURSING ASSITANT MEDICAL RECORD OFFICER CODER MPW (DEO) MPW (DEO) MPW (DEO) MPW (DEO) M.R.T. M.R.T. M.R.T. EXECUTIVE EXECUTIVE CHIEF EXECUTIVE OFFICER MEDICAL RECORDS OFFICER TELEPHONE OPERATOR SR. TELEPHONE OPERATOR SR. M.T.S. MR. SIVASUBRAMANIAN .K SIVASUBRAMANIAN MR. MS.PARAMESWARI SARAVANAN MR. MR. RAVI SELVAM MR. MANOGARAN MR.K. MRS. USHA KUMARI G.R. MRS. SANTHIYA MRS. S. PRIYA MURUGAN. M MR. N. VISVANATHAN MR. SHANMUGHAM MR.B. MS. MALATHI KUMARI MS. R. NADHIRA MS. R. G. SIVARAMAN MR. SUGANTHI MRS. V. MRS. K. RAJESWARI MS. K. SARITHA M. SHANMUGAVEL MR. KUMARESAN R. MR. RAMESHBABU DR. K. SENTHIL KUMAR MR. AROCKIA JOSEPH ANTONY MR.N. K.M. BOSE MR. G.K. BASKARAN MR. S. RAMPAL MR. 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113

165 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] 9159547151 9443535586 9626370099 9994414638 9790836610 9444759351 9629866040 8300782848 9698951882 9940882399 7598535997 9626514514 8903994989 7639836019 9952420762 8220332041 9698955533 8608043055 9629193727 9790216997 9600461261 9677572605 9442263754 8489365305 8682991802 8883810515 9944756533 9442256554 7299892894 JIPMER, PUDUCHERRY JIPMER, AVMC&H, PUDUCHERRY AVMC&H, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PIMS PIMS M.T.S. A.M.R.O. M.R.T. M.R.C. M.R.C. M.R.C. Sr.T.O. M.R.C. D.E.O. M.R.C. M.T.S. M.R.S. M.R.T. M.R.C. M.R.C. M.R.C. M.R.S. M.T.S. M.R.C. M.R.C. M.R.C. M.R.T. R.C.T.O. M.T.S. M.R.C. M.R.C. M.R.C. M.B.B.S. (Student) M.B.B.S. (Student) MR.ANAND KUMAR DEHARIYA KUMAR MR.ANAND MR. B. TAYANIDY MR. MUNIAMMAL V. MR. S. KALIAMOORTHY MR. MRS. N. AMSAVENI MRS. A. NAGAMANI MRS. S.MUTHULAKSHMI S. VIRAPATTIRANE MR. MRS. J. LAKSHMI KARUNANITHI P. MR. S. MUNISAMY MR. K. DAKSHINAMURTHY MR. MRS. S. HEMADEVI MRS. ANDJALADEVY MR.V.MUTHUKUMARASAMY MRS.M.VIJIMALAR MRS.V.VIJAYAVALLI KUMAR MR.SANDEEP MRS.D.SARODJINI MR.A.DHANAGOPAL MRS.S.ANUJA MR.V.VASUDEVAN MRS.S.HEMAVATHI MR.BALASUBRAMANIAN MRS.P.SUGANTHI MR.S.SARAVANANE MR.S.KUTTIYANDI MISS.N.ANJANA MISS.L.ANUPRIYA 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 132 133 134 135 136 137 138 139 140 141 142 131

166 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected]

9994398428 9489841503 9446409912 8903305472 9944560583 8610745383 7674931149 9885802267 8688888682 8807342472 9446946976 9947328220 9446849560 9789271605 8754816420 9881919389 9943093985 9486438997 9789442667 9843361488 9495493247 9446244788 9698939710 9677572605 9750678999

JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, G.M.C., TRIVANDRUM EAST COAST HOSPITAL MGMC&RI, PUDUCHERRY MGMC&RI, PUDUCHERRY RIMS GENERAL HOSPITAL,KADAPA,ANDRAPRADEESH RIMS GENERAL HOSPITAL,KADAPA,ANDRAPRADEESH RIMS GENERAL HOSPITAL,KADAPA,ANDRAPRADEESH G.M.C., AP TN KOVILPATTI, HEAD QTS. HOSPITAL, DIST. KOTTAYAM G.M.C., TRIVANDRUM MEDICAL COLLEGE, ALAPUZHA, KERALA GOVT. PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, KL. THIRUVANANTHAPURAM, RCC, KL. THIRUVANANTHAPURAM, RCC, SAMBA, JAMMU & KASMIR BSF HOSPITAL, PUDUCHERRY JIPMER, SALEM MEDICAL RECORD LIBRARIAN GRADE I GRADE MEDICAL RECORD LIBRARIAN (RETIRED) M.R.S. (RETIRED) M.R.S. M.R.O. A.M.R.O. A.M.R.O. M.R.O. M.S.W. REC. ASST. M.R.A. JUNIOR ASST. MED.REC.LIB.GR-II CLERICAL ATTENDER ASSITANT JUNIOR LABORATORY M.R.C. OFFICER IN-CHARGE, MRD M.R.C. (RETIRED) M.R.T. (RETIRED) M.R.T. (RETIRED) M.R.S. (RETIRED) M.R.S. I CLERK GRADE C.R.A. M.R.T. M.R.T. M.R.T. MRS. MALARKODI KUMARESAN MRS. MALARKODI MRS. S. MOUNOUNIAMMALLE MRS.R.USHA MR.A.COUMARESH MR.SARAVANAN RAO MR.RAMA MR.B.V.R.V.PRASAD MR.K.V.SAIKUMAR MR.M.RATHNAM MR.K.DHANALAKSHMI MR.EDHEL MR.SHALU.C.R. MR.HARIKUMAR.G. .S MR.SHAJ G. LOGANATHAN MR. MITTISILA ANANDARAJ DR. MURUGANANDHAM MR. RAJENDRAN R. A. MR. BOOBALAN S. MINATCHISUNDARAM MR. CANDASAMY R. MR. .B KUMAR PRADEEP MR. S. GIRISH MR. M. SAMSUDEEN VASUDEVAN V. MR. MURUGESAN MR. 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168

167 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] 9500426684 9488494968 9841377869 8608616642 9632367577 9843322139 9843322139 9884919389 9486538031 9442529118 9994076368 7871191919 9500366026 9159281675 9486513815 9597935907 8903824752 9500671642 9632601738

Chettinad Hospital & Research Institute Chettinad Hospital & Research PUDUCHERRY JIPMER, IMCU & TOXICOLOGY, IIM,RGGGH, CHENNAI IMCU & TOXICOLOGY, SALEM KIMS HOSPITAL SLIMS, PUDUCHERRY SLIMS, PUDUCHERRY PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, CHENNAI SIMS HOSPITAL, PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, SVMMC, KARAIKAL PUDUCHERRY JIPMER, JIPMER INSURANCE, JIPMER INSURANCE, JIPMER INSURANCE, JIPMER INSURANCE, JIPMER INSURANCE, JIPMER INSURANCE, BANGALORE JOHN’S HOSPTAL, ST. BANGALORE JOHN’S HOSPTAL, ST. BANGALORE JOHN’S HOSPTAL, ST. BANGALORE JOHN’S HOSPTAL, ST. BANGALORE JOHN’S HOSPTAL, ST. BANGALORE JOHN’S HOSPTAL, ST. BANGALORE JOHN’S HOSPTAL, ST. BANGALORE JOHN’S HOSPTAL, ST. BANGALORE JOHN’S HOSPTAL, ST. DOCTOR CUM TUTOR (RETIRED) M.R.O. COMPUTER OPERATOR M.R.T. M.R.T. S.M.R.O. M.R.O. (RETIRED) M.R.S. JIPMER STUDENT, M.R.T. Consultant - Quality & Accreditation (RETIRED) M.R.T. ADDL. MEDICAL SUPERINTENDENT M.R.O. O.A. D.E.O. M.P.W. M.P.W. M.P.S D.R.L. D.R.L. IN MRD CONSULTANT MRM Student MRM Student MRM Student MRM Student MRM Student MRM Student MRM Student MRM Student DR.SWAMINATHAN VEERASAMI DR.SWAMINATHAN MR. ANAND MR. MS. KIRUTHIKA MRS. VEENA RAMJI MR. RAMJI MRS. BANUMADY N. MOUROUGAIYEN MR. MRS. C.A. SUMANA S. SUDHA MRS.MALLIKA KOTHANDARAMAN N. KOTHANDARAMAN MR. RUSTAGI ANITA DR. ROBERT MR. S. YUVARAJ MR. MS. K. AGALYA MS. E. EZHILARASI S. PARTHIBAN MR. MS. S. SOUMIYA MS. M. VALARMATHI D. BALAJIMR. D. MARIA JOSEPH MR. AROKIASAMY MR. MANUEL KUMAR MR. MR.MANIKANTA KUMAR MR.SATISH RAVIRAJA MR. RIYAZ MR. VIGNESH MR. MACHADO MR.IRENE 169 170 171 172 173 174 175 176 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 177

168 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA [email protected] [email protected] [email protected] [email protected] gopinath.pande@ bhaktivedantahospital.com, [email protected] [email protected] [email protected] [email protected]

9985369360 7698815044 9843567862 9994480907 9442486032 9092029805 9751286441 9787431731 9773667669 9773297798 9322815323 9912369111 9920978102 9505335784

Basavatarakam Indo American Cancer Institute,Hyderabad INTERNATIONAL HOSPITALS APOLLO LIMITED,Gujarath ST. JOHN’S HOSPTAL, BANGALORE JOHN’S HOSPTAL, ST. BANGALORE JOHN’S HOSPTAL, ST. BANGALORE JOHN’S HOSPTAL, ST. BANGALORE JOHN’S HOSPTAL, ST. BANGALORE JOHN’S HOSPTAL, ST. BANGALORE JOHN’S HOSPTAL, ST. BANGALORE JOHN’S HOSPTAL, ST. PUDUCHERRY PIMS, KALAPET, PUDUCHERRY JIPMER, PIMS PUDUCHERRY JIPMER, PUDUCHERRY JIPMER, PIMS, PUDUCHERRY SLIMS, PUDUCHERRY SMVMCH, PUDUCHERRY SMVMCH, PUDUCHERRY Apollo Hospitals ,Mumbai Apollo Hospitals,Mumbai Bhaktivedantahospital,Mumbai Aayush NRI LEPL Healthcare Pvt Ltd,Vijayawada Memorial Centre,Mumbai Tata Basavatarakam Indo American Cancer Institute,Hyderabad Sr. Manager HIM Sr. AGM-PHARMACY & MEDICAL RECORDS MRM Student MRM Student MRM Student MRM Student MRM Student MRM Student MRM Student M.R.S. R.C.T.O. M.R.T. RETIRED RETIRED M.R.T. M.R.T. M.R.S. A.M.R.O. Executive - HIM Executive - HIM Assistant MRD MANAGER HIM Officer Medical Records Executive - HIM MR. BEENA THOMAS MR. MS. ABEL ROSE MARY MS. MARY STELLA MS. PAVITHRA MS. G. PRIYANKA MS. S.PRIYANKA MS. YAMUNA PRIYA MRS.SUMATHI N. SANKAR KUMAR MR. MS.SINDUJA MR.S.NARAYANASAMY MR.M.G.RAMACHANDRAN MRS.RAMANI MRS.R.ATHILAKSHMI MR.R.MOORTHY JOSEPH MR.M.ISWIN Ms. Nilakshi B Jadav Ms. Samiksha S Tenbalkar Gopinath Balu Pande Mr. KARRI RAO NAGESWARA MR. Madhu Mohan Maddirala MR.. MOHAMMED ZAKIR HUSSAINMR. Ch.Balaraju MR. NIPUL SHANTILAL KAPADIA MR. 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221

169 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] 7698815044 8518881795 7036666700 9751960788 9849332068 8867835340 9949750983 9704733308 9987330365 9912374111 9538030456 99954101411 9072504378 9493279595 8903647212 9567115976 9573065063 9908123250 9847098098 9092122254 ,Chennai

APOLLO HOSPITALS INTERNATIONAL INTERNATIONAL HOSPITALS APOLLO LIMITED,Gujarath AIIMS RAIPUR,Raipur SPECIALITY CARDIAC AND MULTI DR RAMESH PVT LTD,Guntur HOSPITAL Dhanalakshmi Srinivasan Medical College & Hospital,, Perambalur NIMS ,Hyderabad ,Bellary Melmaruvathur Kanchipuram District ,Hyderabad Apollo Hospitals, ,Hyderabad AIIMS,Raipur Aayush NRI LEPL Healthcare Pvt Ltd,Vijayawada Medical College Hospital & Sri Venkateshwaraa Centr,Puducherry Research & MEDICAL ESIC MODEL HOSPITAL COLLEGE,BENGALURU Govt. MEDICAL COLLEGE KOZHIKODE,Kerala AMALA INSTITUTE OF MEDICAL SCIENCES,Kerala SPECIALITY CARDIAC AND MULTI DR RAMESH PVT LTD,Guntur HOSPITAL Clinic Hospital ,Coimbatore Poly RAM Metro Med international cardiac centre,Islam Calicut Adhiparasakthi Dental College & Hospital, -, Narayana Hospital ,Bangalore Hospital ,Hyderabad Yashoda Mother Hospital, Greatland, Ugrapuram P O,Kerala AGM-PHARMACY & MEDICAL RECORDS PROFESSOR ASSOCIATE MANAGER IT Asst. General Manager Technician Medical Records President HIMA President MANAGER HIM Officer Medical Records Manager IT Officer Medical Records Sr. SENIOR MEDICAL RECORD TECHNICIAN Superintendent Medical Records Officer Medical Record MANAGER DEPUTY GENERAL Officer Medical Record Technician Medical Records Officer Medical Recoed Dyp Manager MRD HOD MRD HOD IT Dr SHREMANTA KUMAR DASH KUMAR Dr SHREMANTA LAXMI VASIREDDY MR. PRASAD RAMALINGAREDDYKESARI MR. MR. KAPADIA NIPUL SHANTILAL KAPADIA MR. G D Mogli Prof. Subhakar Medepalli MR. I T KALLESHWARA MR. SARADHI V PARDHA MR. Ramachandiran V. MR. GOUDAR KASHAPPA MR. Rao Keshava T. MR. HAKIM SHERIFF M MR. MS. STEFY JOSEPH M DR MAHESHWAR K GOGULRAJ MR. MAHESH BABU KASIVAJHULA MR. Savad MR. S DAKSHNAMOORTHY MR. Aaryala Papaiah MR. DANDA PRABHAKAR MR. Mohammed Sajid MR. 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 238 239 240 241 242

170 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected]

[email protected] 9620463547 9010772424 9633939623 9003331097 9941277220 9400410974 8433706344 9677707645 9895605367 9032541388 9989833699 7829380454 9620343571 9742258849 9177592848 9884215156 9902548419 9751153889 9789377354 8098256569 7639664251 9789474207 9742258849 9849919074 ,Chennai

Ramaiah University of Applied Ramaiah Sciences,Bangalore Kauvery Hospital Chennai Sri Venkateshwaraa Medical College Hospital & Sri Venkateshwaraa Centr,Tirupathi Research Apollo Hospitals ,Hyderabad National Institute of Siddha,Chennai National Institute of Siddha,Chennai Apollo Hospitals ,Hyderabad D. Hinduja Hospital,Mumbai P. SIMS Hospital,Chennai Cheranallore,Cochin,Kerala Aster Medcity, All India Institute of Ayush,Delhi Physiomedsolutions,Hyderabad University of Applied Ramaiah Sciences,Bangalore University of Applied Ramaiah Sciences,Bangalore University of Applied Ramaiah Sciences,Bangalore Hyderabad Apollo Hospitals Ramaiah University of Applied Sciences Ramaiah CMC Vellore CMC Vellore CMC Vellore CMC Vellore CMC Vellore University of Applied Sciences Ramaiah Student - MHA MRD Techinician Executive - HIM Dyp. Medeical Superintendent Matron Executive - HIM MANAGER HIM Asst.Manager MRD Techinician Manager HIM Sr. Director Assistant Manager Operations Student - MHA Student - MHA Deputy Administrator HOD MRD Student - MHA BMRsc - Student BMRsc - Student BMRsc - Student BMRsc - Student BMRsc - Student Executive - HIM Deputy Administrator MR. C Hari Prasad MR. VISHNU V S MR. Madhavan Radhika Dr. MS. B. Sangeetha Jebin Jose MR. CHELLADURAI JEBARAJ MR. MS. V.Sudhamathi MATHACHANa MR. Shaik Abdul Rahaman MR. KRUPANAND.P WYCLIFFE DR. RUFUS SHAKIN MR. MS. Suvenitha Dhakshina Murthy Y P MS. Ramya K H Shrinidhi Prasad MR. Kamath U Ramachandra MR. Kishore Babu MR. Dr. Sneha Ashwani Sharma Dr. R Deepak Kumar Mr. Abishek P Mr. Samuvel Raj Mr. Cheeru harilal Mr. HARSHA.J Mr. E Sudhakar Raju Mr. Kamath U Ramachandra Mr. 243 244 245 246 247 248 249 250 251 253 254 255 256 257 258 259 260 261 262 263 264 265 266 252

171 JIPMER HIMA ASIA CONFERENCE - 2017 GOLDEN JUBILEE CELEBRATION OF MEDICAL RECORDS EDUCATION AND EXECUTION IN INDIA

Dr. Anandraju Mittisila Officer In-Charge Medical Records Department, JIPMER & Vice Chairman JIPMER HIMA Asia Conference-2017 VOTE OF THANKS Dear Delegates! On behalf of organizing team, It gives me immense pleasure in inviting the delegates and the eminent speakers from various parts of India as well as from overseas. I congratulate the organizing committee who enthusiastically took extra pain right from the beginning to the end of this conference in making this event a great success. I also thank ancillary services who were involved in the maintenance , decoration and sanitation etc. I great fully thank commercial units who have come forward and contributed the fund liberally. I specially thank our Mentor Dr.Anitha Rustagi, Additional Medical Superintendent ,jipmer for guiding us all the way in organizing this conference in an extraordinary manner or else we would have not achieved this much great goal without her guidance. I specially thank Dr. G.D. Mogli for the steps taken to initiate this conference. Our sincere thanks to Director, JIPMER Dr. SC. Parija, Dean (Academic) Dr. RP. Swaminathan and Medical Superintend Dr. Ashok Bade for supporting us to organize this conference. Dr. Anandraju Mittisila M. Subhakar Laxshmanan Mallika Kothandaraman Viswanathan Ravichandran

172 JIPMER HIMA ASIA CONFERENCE - 2017