The Role of Electronic Medical Charting in Healthcare

With our easy access to over-the-top media services, aka OTT, social media platforms, and a wide range of wellness apps, most young Indians are accustomed to digital conveniences. We take them for granted, assuming that digital health tools like Aarogya Setu and Ayushman Bharat Health Account (ABHA) are the norm, but this simply wasn’t the case just a decade ago. Traditionally, Indian healthcare providers had to maintain their own patient records, writing them down on paper and storing data in physical files and cabinets. Not surprisingly, record-keeping was time-consuming and plagued by problems, resulting in the loss of historical health data, unnecessary testing, delayed treatments, and treatment errors. 

That’s all changing with the rise of digital India and our shift towards electronic medical charting systems. These initiatives are being spearheaded by both the Government of India and private enterprises, aligning with the Ayushman Bharat Digital Mission. Widely described as electronic medical records (EMRs), these electronic charting systems ensure that all of your health data is consolidated and stored securely, so that it can help streamline healthcare delivery, improve medical outcomes, provide personalised care, and empower you to actively participate in your health management.

What is electronic medical charting?

With electronic medical charting or EMR charting, patient health information is recorded and documented using digital platforms instead of traditional paper records. This is transformational for healthcare as it does a lot more than consolidate and store data safely, which was otherwise easily lost, misplaced and vulnerable to damage. It enables instant, real-time access to patient data as changes are recorded and retrievable immediately. This allows doctors to respond swiftly, making accurate treatment recommendations based on the latest patient information. What’s most important is that authorised healthcare providers can now access records remotely, facilitating coordinated, holistic care as compared to fragmented care, which was the norm before. 

In addition, electronic medical charting systems eliminate many problems of human error, such as those stemming from illegible handwriting or vagueness. EMRs also enable other features that benefit patients and health systems, such as automatic alerts for allergies or drug interactions, adverse event reporting systems, and lots more that we are only now beginning to explore.

Evolution from paper charts to digital systems

Medical record keeping has been evolving ever since the practice began in ancient times, with formal record keeping in a more or less standardised format only beginning in the 19th century. Although this was in itself a huge advance, there were several limitations with paper records, prompting researchers and experts to pursue the development of EHR or EHR charting systems. 

This process of evolution began in the 1970s, but was hampered by high costs and infrastructure needs. By the late 1980s and early 1990s, more affordable, powerful PCs and internet access enabled web-based EHRs. During the first two decades of the 2000s, EHRs continued to mature and grow, with increased adoption in global healthcare systems. However, the biggest boost came from the COVID-19 pandemic, which accelerated digital uptake of almost all health solutions, including electronic medical charting.

Key features of electronic charting systems

As EHR charting systems evolved over the years, the features that they offer have steadily increased. 

• Real-time data entry: Immediate documentation of patient encounters

• Customisable templates: Standardisation of data collection and organisation tailored to specific specialities or patient groups

• Medication tracking: Monitoring prescriptions and sending alerts for dosage requirements or potential interactions

• Integrated diagnostic tools: Access to lab results, imaging, and other diagnostic data

Benefits of electronic charting in clinical practice

Aside from the obvious benefits of improved and rapid access to patient records, which improves healthcare delivery, electronic charting has demonstrated benefits in other areas too.

• Improved accuracy: Its use can reduce errors associated with manual documentation.

• Enhanced patient safety: Better monitoring of patient response to treatment and alerts to ensure adherence or warn about adverse events.

• Decision support systems: Provide evidence-based recommendations so that healthcare providers have all the available information to make the best clinical decisions.

• Better resource management: It enables advanced data analytics and AI-powered diagnostics, thereby reducing pressure on limited healthcare resources.

Common challenges in adopting electronic charting

Despite the obvious benefits of electronic charting systems, there are several challenges that limit adoption. These include:

• Healthcare professionals can be hesitant to change established workflows, and some may resist new technologies.

• Lack of skill upgrades and training results in improper use of systems, reducing their efficacy.

• Poor interoperability of new medical charting systems limits the potential for integration and complicates digitisation.

• The initial investments required may seem prohibitive to many, despite the potential for long-term savings.

• Patients and healthcare providers have expressed concerns about privacy and data security.

Addressing these challenges will be key to widespread adoption of EMRs so that we can meet the growing healthcare needs of our population over the coming years.

How electronic charting enhances patient care

Many of the benefits of electronic health charting that we have already described concern patients and patient safety. However, there are some other patient-specific benefits that may be less obvious, such as better continuity of care and holistic management of complex health conditions, which is only possible when multi-speciality teams work together. This kind of collaboration is only made possible through EMR or EHR charting. 

When healthcare providers have improved access to consolidated health records of patients, there is less waste and unnecessary cost, as patients do not need to undergo unnecessary tests and procedures. Moreover, the analysis of EHR data allows for easier identification of high-risk patients so that we can focus more on preventive care. These patient portals can also help raise awareness about common health conditions and personal health, making patients more engaged and empowered in their health journeys.

Use cases and real-world examples

There is growing evidence to support the use of electronic medical charting systems, with many notable examples.

• Faced with user resistance because of limited IT skills, Sankara Nethralaya Hospital, in Chennai, adopted a participatory design approach, customising their EMR interface to mirror familiar paper workflows, while providing hands-on support for hesitant staff. This led to high adoption rates, facilitating improved telemedicine access and reduced storage space, making the approach ideal for resource-constrained settings.

• Another study involving 349 hospitals in the US revealed significant benefits from EHR implementation under the Health Information Technology for Economic and Clinical Health (HITECH) Act, which aimed to leverage the technology for higher efficiency, quality, and patient safety. Among other benefits, they observed a reduction in postoperative physiologic/metabolic complications by over 200% and a reduction in postoperative wound opening by at least 86%.

• A government civil hospital in Gandhinagar, Gujarat, India, deployed a ready-to-use Health Management Information System (HMIS) framework, creating a Project Implementation Unit and central help desk, and involving users in proof-of-concept reviews. Over 95% of clinicians reported that reviewing patient problems and retrieving specific information became easier, while 92% to 96% found the data accurate, up-to-date, and accessible, improving efficiency and outcomes.

• An analysis of ACA-Era US Hospitals’ adoption of EMR found considerable benefits for patients and health systems, with reductions in post-event mortality by 34% and readmissions by 39%. They also noted that there was a $1.75 return per $1 of IT investment.

The future of medical charting in a digital healthcare ecosystem

The future of medical charting is poised to embrace advanced technologies, including:

• Voice recognition, which will enable hands-free documentation, improving efficiency.

• Automated data entry and clinical decision support through AI-assisted charting.

• Virtual and augmented reality (VR/AR) will create immersive, intuitive interfaces for clinicians.

• Improvements in interoperability will facilitate seamless data exchange across systems and providers.

• The use of technology such as blockchain could strengthen data security and integrity.

We are at the cusp of the digital health revolution and will continue to see such innovations gain wider acceptance as they help streamline clinical workflows, enhance patient engagement, and improve healthcare outcomes.

Frequently Asked Questions

1. What types of healthcare organisations benefit from EMRs?

EMRs can improve efficiency and outcomes for all types of healthcare organisations, from small private practices to large hospital networks. EMRs help by streamlining workflows, eliminating waste, and improving data access.

2. How does electronic medical charting help patients?

In addition to empowering patients with easy access to all their medical information, patients can also receive better and coordinated care from their healthcare providers.

3. How do EMR systems help reduce healthcare costs?

As EMRs improve patient outcomes, they can produce significant reductions in healthcare expenditure. Costs for healthcare providers are also reduced as they have reduced costs of maintaining paper-based systems, storage space, and administrative burdens.