Demonstrating benefits to patients and clinicians will greatly drive interoperability, health information exchange and medical record digitalisation in Asia-Pacific.

Dr Mahesh Appannan, Ministry of Health Malaysia's head of digital health, Seyoung Jung, assistant professor and CIO of Seoul National University Bundang Hospital in South Korea, and Gareth Sherlock, chief executive of Turimetta Consulting and former CIO at Cleveland Clinic London and Abu Dhabi, delved into EMR implementation best practices and challenges in the panel session, "The EMR Experience in Asia-Pacific," at HIMSS24 APAC.

Sharing initial findings from their latest region-wide survey on healthcare providers' experiences in using EMR systems, HIMSS's APAC managing editor Thiru Gunasegaran, who also served as panel moderator, noted that clinicians spend between five and six hours on average on the EMR system. 

When asked what should be a good amount of time to spend on EMR, Sherlock promptly answered "as little as possible." Time spent on the EMR, he said, is driven by such factors as specialty, payer expectations, and regulatory compliance. 

For Dr Appannan, it depends on the type of case. "Complex cases require more time." He said the time a pharmacist spends following up with doctors about their prescriptions should also be accounted for.

Systems automation, which sees growing adoption across health facilities, can also help save time completing an EMR, Dr Appannan added. "Our doctors in electronic clinics in Malaysia can see a patient within 10 minutes because we have innovative ways of making templates… and that saves a lot of time. We also [use] voice-to-text which [automatically populates clinical notes] while we speak to the patient."

In the context of the ongoing doctors' strike in South Korea, Dr Jung said medical professors now "do not have enough time" to put complete medical information in a patient's EMR. 

Demonstrating benefits

The panel also discussed challenges and best practices in hospital and health data integration and sharing. 

"I could go to a hospital in central London… and [go] down the street to a private hospital. One has an EMR while the other's on paper. They have different cultures, staffing numbers, workflows, outcomes.. if that is happening within a couple of kilometres from each other, that shows you the wide disparity and huge challenges we have," Sherlock said, demonstrating his point that many organisations are still largely paper-based. 

"We need to get that alignment and standardisation and look at data quality [to start enabling data exchange]."

While agreeing, Dr Appanan emphasised that organisations must not forget to include the most crucial actors of health data exchange and interoperability – the patients. "Patients [are] the mediators of health information exchange."

"We need to include our patients [so they can] take charge and have the information at their fingertips."

To encourage patients to consent to – and eventually promote – health data exchange, demonstrating best-case scenarios may be key, according to Dr Jung. In SNUBH, for example, an AI-powered continuous blood glucose monitoring system called Pasta has been recently integrated into the EMR system, conforming to HL7 FHIR standards. "The [mobile] solution helps patients to manage their blood sugar level by themselves. It also guides their lifestyle changes."

Driving change management 

Another key finding from the survey was that clinical decision support systems are the most challenging efficiency tool to implement in hospitals.

Commenting on this, Sherlock said it will take a "massive cultural shift" to have doctors confidently use CDSS. "They need to be on the journey from start to finish and understand how everything is going to change when they move to this new way of working. In the end, it's their system."

"The toughest people to change are physicians themselves… There is always something to be rebutted," Dr Appannan added.

Citing a potential use case of CDSS amid the growing global Mpox outbreak, he said: "It’ll be helpful for nurses and rural doctors who are not up to date with the latest clinical development. CDSS [must be] mandatory. In Malaysia, it is a requirement to have some sort of a clinical decision support."

Dr Jung stressed another issue: the lack of post-CDSS implementation analysis. "Colleagues have complaints about CDSS but don't have ways to report them." 

This then leads to distrust in using CDSS, he claimed. SNUBH is now looking to get validated for the new AMAM24 model, which also evaluates an organisation's analytics life cycle from development and implementation to evaluation.  

Collaborative effort

Dr Appannan refers to the process of implementing and deploying EMR as a "science." "Before we deploy and implement EMR, planning – including having the basic infrastructure and connectivity – is crucial… You need to have a fantastic pre-deployment strategy."

The Malaysian government, he said, is now focused on getting all stakeholders in the health system together to collaborate on developing standards for digital transformation. 

In making national mandates to take up EMR and enabling health record sharing, Sherlock suggested providing incentives.

In general, Sherlock suggested mulling over the intended outcomes an organisation wanted from implementing EMR. 

"What are the big things you would like to deliver on? What are the clinical and business processes that need to change to make that happen? Then, explore technologies to enable those business processes to deliver those outcomes."