Can sharing your personal health records with your physician be as easy as sharing your Instagram profile with your friends? Aren’t you tired of doctors asking you the same questions about your allergies every time you enter the emergency department?
The reason for this is due to a lack of Electronic Medical Records (EMR) or Electronic Health Records (EHR) in Malaysian public hospitals and clinics.
EMR is a collection of medical information about a person that is stored on a computer. The information may include the patient’s comorbidities, past hospital admissions, current medications, baseline blood test results, allergies, immunisation status, and others.
Not every public hospital in Malaysia has a EMR system. Recently, the government has announced the implementation of the EMR initiative in phases as part of the 12th Malaysia Plan (MP12).
Even in 2019, under the Pakatan Harapan administration, then-health minister Dzulkefly Ahmad planned to fully implement EMR systems in all government hospitals and clinics over the next five years. When was the initial plan, though?
According to Binti Ismail and Binti Abdullah, the EMR system is a core system of the Health Information System (HIS). The HIS implementation was planned during the Sixth Malaysian Plan in 1993.
In July 2020, the previous health minister, Dr Adham Baba, stated that only 25 per cent of public hospitals and 9 per cent of public clinics are using the EMR system.
In the same paper, the authors also discussed that cost-related issues, technology-related issues, human-related issues, legal issues, and unique issues (such as budgets, number of beds and new or old hospitals) were factors blocking EMR adoptions(1).
In addition to that, hospitals that have the EMR system implemented are not centralised. Accessibility and the sharing of patient’s information between doctors in different hospitals can be time-consuming.
How can a centralised EMR benefit us during the current Covid-19 crisis, and how does it help with managing non-communicable diseases?
During the pandemic, one of the challenges for health care workers were patients not informing them if they were waiting for test results or were close contacts with a positive case.
When the patient turned out positive, a large number of staff needed to be tested and isolated. This has strained an already burned-out health care system.
Now, try to imagine a robust contact tracing system, consisting of both QR codes, Bluetooth features and uploaded test results, linked with a centralised EMR of each person?
Like how the police can look for an individual’s past criminal history in their system, a health care worker should be able to do the same with new patients using a centralised EMR system. By having this, unnecessary quarantines and potential outbreaks can be avoided.
Last year, smart contact tracing was able to identify 627,386 potential contacts from the Diamond Princess passenger cruise ship in Taiwan. Automated alert messaging for self-restriction was sent out, and using health insurance data, surveillance of the contacts was done(2).
With a robust contact tracing system and vaccination status linked with a centralised EMR, big data analytics can be done. We can then be able to train a deep learning model to answer these important questions:
- Where will the next outbreak happen?
- Which cluster will require more medical attention. based on comorbidities?
- Which area will need a targeted lockdown based on demographics?
One of the best ways to prevent non-communicable diseases is a healthy lifestyle, i.e. eating healthily and exercise regularly. Are we monitoring enough, though? Most of the time, data capturing is being done manually.
Now, imagine if we can monitor it in real time. With the rise of the Internet of Medical Things (IoMT), we can monitor an individual’s exercise schedule and even their heart rates.
With a centralised EMR system, data can be uploaded from wearable devices. Imagine a doctor saying, “Looking at the system, you exercised four times each week this month. Congratulations!” This kind of positive encouragement will be initiative for a person to adopt a healthy lifestyle.
According to Arunah Chandran, Shurendar Selva Kumar et al, “The adoption of electronic health records (EHR) could improve the availability and accuracy of data from healthcare facilities. Databases of healthcare facilities providing longitudinal electronic health records data allow patterns to be detected in real time, as well as rapid shifts in morbidity, risk factors and delivery of health care. These databases become a reliable repository for NCD surveillance if it can be cross-referenced across public and private health facilities and provide a platform for meaningful local action(3).”
With a centralised EMR system, clinical researchers can conduct research faster. According to the 2019 National Health Morbidity Survey (NHMS), 50.1 per cent of Malaysian adults are either overweight or obese. Have we passed the point of no return?
Until now, 26,335 Malaysians have succumbed to the Covid-19 virus. Were we late to act? In medicine, time is crucial. For us to beat the pandemic or win against the prevalence of NCDs, we need to be one step ahead. Technology advancements in the medical field can help us with that. If we want to seriously improve our health care system, we need a centralised EMR system.
- Binti Ismail NI, Binti Abdullah NH. Developing electronic medical records (EMR) framework for Malaysia’s public hospitals. 2011 IEEE Colloq Humanit Sci Eng CHUSER 2011. 2011;131–6.
- Chi-Mai, Jyan H-W, Chien S-C, Jen H-H, Hsu C-Y, Lee P-C, et al. Containing COVID-19 Among 627,386 Persons in Contact With the Diamond Princess Cruise Ship Passengers Who Disembarked in Taiwan: Big Data Analytics. J Med Internet Res 2020;22(5)e19540 https//www.jmir.org/2020/5/e19540 [Internet]. 2020 May 5 [cited 2021 Sep 30];22(5):e19540. Available from https://www.jmir.org/2020/5/e195403.
- Chandran A, Selva Kumar S, Hairi NN, Low WY, Mustapha FI. Non-communicable Disease Surveillance in Malaysia: An Overview of Existing Systems and Priorities Going Forward. Front Public Heal. 2021 Jul 6;0:913.
Dr Azim Nasaruddin is a medical officer at the Clinical Research Centre, Hospital Rehabilitation Cheras.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.