Implementing electronic medical records: still in progress

	Removing problems in classification of medical equipment
	Firm falsifies licenses to import shipments of medical equipment
	Warning over declaring medicine as medical equipment

The implementation of electronic medical records brings many advantages for patients and medical facilities. Photo: Ho Tiep

Many "congestion points"

According to Circular 46/2018/TT-BYT on electronic medical records, from March 1, 2019, health facilities will use electronic medical records instead of medical examination books. After more than five months of implementation, up to now, according to the Information Technology Department, Ministry of Health, there are 14 medical facilities in the country using electronic medical records only.

Tran Quy Tuong - Director of Information Technology Department said the information technology infrastructure at medical facilities was not synchronous. Therefore, they are still confused and do not know what items to invest in and upgrade to be able to deploy electronic medical records. Besides, financial mechanism for the application of medical information technology and the deployment of electronic medical records in particular were not clear (there was no item for information technology, no information technology component in the medical service costs), hospitals mainly use their investment and development fund to apply information technology, affecting other activities.

Regarding hospital management software, according to the Director of Information Technology Department, the Ministry of Health has no uniform standard for the whole health sector. Most medical units and facilities have to manage and invest in hospital management software on their own.

“According to regulations, when units deployed electronic medical records, the main software for medical examination and treatment facilities had specific standards. The current difficulty is that facilities do not have common standards for each connection. The Information Technology Department is proposing to build and deploy a common ID,” said Tuong.

For health facilities, a leader of Phu Tho General Hospital said to implement electronic medical records, the hospital must use new software, which would be inappropriate to reality and need to be edited a lot. Besides, the hospital’s network infrastructure was not synchronous and the speed was slow, not meeting the actual demand. Many hospital’s old imaging machines cannot return results to the software.

In addition, the hospital leader admitted implementing electronic medical records required all staff to change their habits, processes, operation on the system, but their level of information technology was not uniform, making it difficult for training. Moreover, information technology staff have many limitations in knowledge and medical professional process.

Regarding difficulties of the establishment in implementing electronic medical records, Nguyen Thanh Hoi - Director of Hai Phong International General Hospital said many clinical results such as electrocardiography, electrocardiography holter, blood pressure holter, EEG, bone density measurement; ultrasound image needed to be printed out, so electronic medical records were not really completed. Besides, there was no link among medical facilities, patients could not receive and transfer their results between units by USB, CD.

In particular, according to Hoi, the principle of electronic medical records is to carry out electronic signatures, but since there is no specific law on this, many forms still need “wet ink” signatures. After that, the hospital must integrate the sample, print it from the computer, then scan it back into the electronic medical record and save the copy with the “wet ink” signature, which takes time and money. Meanwhile, the Ministry of Health has not put information technology costs into current medical service costs. Health workers themselves are very worried when implementing electronic medical records because of the legal value of digital signatures and the security of electronic medical records.

Implement flexibly

Proposing electronic medical records, according to a representative of Quang Ninh Obstetrics and Gynecology Hospital, it is impossible to have one shirt that fits all. Therefore, implementing electronic medical records needs an open design to flexibly adjust each stage based on the principle of meeting industry standards and international standards.

In the opinion of Duong Duc Hung - Head of the General Planning Department, Bach Mai Hospital, the important thing of electronic medical records is that there must be a link between health facilities, because a patient is not going to only one hospital for medical examination and treatment, but should also be able to be treated in many different ones. Electronic medical records only become real when this information is linked. The Ministry of Health needs to come up with a standard for all hospitals so they can retrieve and extract patient’s information in other ones when necessary. Otherwise, when patients move to another hospital, they have to conduct paper procedures and when they go to another hospital, they have to re-implement medical records from the beginning. Thus, the implementation of electronic medical records will be half-hearted.

On the side of the Ministry of Health, according to the representative of the Information Technology Department, the cost for hospital management software, infrastructure of information technology is expensive. “There are seven component structures in the price of one health service, but information technology is not one of the seven component structures. Therefore, the Ministry of Health is building the cost of information technology services as the eighth structure, in order to facilitate the investment in information technology in electronic medical records,” said Tuyen.

Concerning the fact that the implementation of electronic medical records will reveal the patient's information, Tuong affirmed that ensuring the confidentiality of patients' information when implementing electronic medical records was very important because they are part of confidential data. Therefore, the use and exploitation of electronic medical records must be done in accordance with the Law on Examination and Treatment. There should be clear rules about who can reveal them, because securing the patient is one of the physician’s oaths.

“The hospital director must promulgate regulations on electronic medical record exploitation. It is necessary to specify which part of medical records that subjects such as interns, researchers and practitioners in medical facilities are able to see and copy to serve their research and professional work. They cannot take them out of the scope of record management in computers,” Tuong said.