Nigeria should switch to electronic medical record system

The health ecosystem in Nigeria needs to undergo technological transformation for a positive impact on health outcomes among our citizens. One of such innovations is the migration from the archaic paper and pencil to a digital system, popularly referred to as EMR, which stands for Electronic Medical Record. In the digital system, instead of a health provider documenting patients’ narratives and findings on a paper, the medical records are stored electronically using software programmes.

The EMR systems are a kind of data warehouses that store information about patients including socio-demographic characteristics; diagnoses of patient’s current and previous conditions; details about medications; laboratory tests, records of vaccinations, and details about allergies. In addition, EMR can be employed as a digital tool to perform other tasks, such as serving as online portals to facilitate patient access to their medical information; assisting physicians to avoid errors in making drug prescription; placing orders for specific laboratory tests; built-in connections with coding and billing software to facilitate payments by NHIA (National Health Insurance Authority).

With the use of EMR, a health facility can determine the burden and trends of communicable and non-communicable diseases that occur in its locality, and to detect disease outbreaks, further demonstrating the applicability of the EMR for nationwide disease surveillance, preparedness and response. Currently, only a few medical facilities in Nigeria are wired to an EMR, a situation that needs to improve so that patient’s experiences and outcomes are enhanced positively. There are many merits/benefits of an EMR system.

First, the EMR limits paperwork while boosting efficiency and productivity. The reduced paperwork for staff means clinicians will spend more time with their patients to clinch an accurate assessment and diagnosis. Instead of treating only symptoms due to lack of time because of heavy paperwork burden, the EMR approach offers more patient-provider interaction time to uncover the roots/causes of patients’ complaints. This results in a quick prescription and referral delivery, which reduces the amount of time patients have to wait for appointments and pickups of prescription.

Patients can be alerted by automatic reminders when it’s time for their yearly physicals or when they approach milestones that call for routine screenings. Further, billing and insurance claims can be submitted on time with integrated patient tracking and ascertainment.

Secondly, the EMR enables feasible data collection for more personalized therapy, which allows healthcare providers to address health issues promptly. Additionally, integrated “big data” analytics on combined patient data might be used to notify medical professionals about more significant health trends, such as imminent disease outbreaks (e.g., the recent diphtheria epidemics in Kano) and the emergence of new health threats in the community.

Also, the EMR drastically reduces administrative costs by eliminating the need for paper transcriptions, physical chart storage, coding, and claims management. It also renders care coordination easier and faster. The EMR shortens the time it takes for clinicians, labs, pharmacies, and health plans to communicate bi-directionally, and to address complicated issues real-time. The current paper and pencil methods of communication are comparatively inefficient, time-consuming, and cost-prohibitive.

Furthermore, the EMR systems provide timely access to patient information and integration of that information with order entry, decision support, and care-planning networks. They also serve as the data source and portal for communication with other providers, patients, and insurers.

Access to EMR over the years has strengthened consumer compliance with prevention, disease management, and care guidelines; boosted hospitals’ administrative efficiency; and increased safety and coordination among providers. The EMR diminishes health inequity due to lack of medical access among socio-economically marginalized populations, cuts down on risk performance assessment, averts medical errors, and suppresses inaccurate decision-making in patient management processes.

Another important issue relates to the nomenclature of EMR (electronic medical record) versus EHR (electronic health record), and the confusion that often results from their usage. We believe it is important to shed light on the differences and similarities regarding the two acronyms to guide policy-making and regulatory processes in the Nigerian health ecosystem.

The EMR and EHR are computerized medical record systems that store patient’s sensitive information which includes diagnostic procedures, lab investigations as well as plan of care and placement of orders. The EMR is relatively more secure than EHR because access to patient data is highly restricted allowing only authorized users to see patient information, which is only available within the same organization. EMR is not designed to be shared outside of an individual clinic or hospital. This is an important distinction from EHR, which allows its users to share patient medical history, regardless of the location and across different provider settings.

Both systems are accessible immediately at any unit work-station whenever needed. Electronic data allow easy transaction to be accomplished simultaneously from remote sites assuring prompt retrieval and processing of patients’ information. Both EMR and EHR allow patient portability where the files can be sent instantly via emails.

The EMR is more affordable to implement as a single institution because it is only accessible within the same organization, hospital or clinic, unlike EHR that requires more resources to make it accessible across different organizations and locations.

The EHR allows authorized users to exchange information with one another remotely and in real-time, making sure every clinician dealing with a patient has a current, complete and accurate file both in the organization and at other locations while EMR is restrictive in that regard.

The EMR is easier to navigate and users could be trained within days to be able to use the platform efficiently. Contrastingly, EHR may take months or even years to accomplish its proper implementation and efficient utilization. On its part, the EHR is built in a way to facilitate patient transfer and referral because multiple authorized users can access it across different health facilities while EMR does not permit such a wide access across different health institutions.

Both EMR and EHR are digital records that allow better tracking and more standardised documentation of patient interactions, a step that reduces medical error. With digital trails, illegible handwriting in clinicians’ notes or prescriptions is no longer a problem and coding for procedures or billing is easier.

The Kano Independent Research Centre Trust are currently discussing with the Kano Centre for Disease Control to use the EMR system in a way that enhances capture of disease outbreak signals statewide. The EMR will help in supply chain management, logistics and medication inventory.

Professor Hamisu Salihu, MD, PhD, is of the Kano Independent Research Centre (Pfizer Research Centre), Kano [email protected]