Clinical and Financial Impact of spinal cord injury on patient’s life
Spinal cord injury (SCI), which results in agonizing loss of sensation and function leads to psychosocial, emotional and financial distress along with physical trauma. The most common causes of SCI injury world-wide are traffic accidents, cancers, falls and sport injuries. The incidence of complete tetraplegia and paraplegia (AISA) can be up to 50.6% and 85.1% respectively. 71% of SCI patients are of the younger age group (20-49 years). The higher SCI incidences are among younger age groups who are often the bread-earning members of the family. The exorbitant treatment makes SCI a major socio-economic burden for the families. Treatment expenses are proportional to the level of injury; higher the injury level, longer is the hospitalization and greater the cost.
Importance of Rehabilitation
SCI rehabilitation is a fundamental and multidisciplinary process. To avoid complications and regain the most possible independence various rehabilitation protocols are followed. The rehabilitation process typically begins with acute and subacute setting rehabilitation. Occupational therapy is an important aspect of rehabilitation. It helps in restoring the psychological, social and emotional state of the patient. The severity of the injury determines the duration of rehabilitation.
Clinical patient management
Rehabilitation commences as soon as the patient is declared medically stable after the injury. Rehabilitation strategies are unique for each patient and the duration can vary from a few days to months. Treatment protocols are designed on the basis of the type of injury and paralysis caused. The rehabilitation process post-acute treatment is an on-going process and requires a team of specialists. Even minute changes shown by the patient are of prime importance and are noted. The diagnostic reports and progress notes in the majority of health centers are maintained using paper-based methods. A few private hospitals adopted the hybrid system i.e., individual patient records are maintained in both paper and electronic format.
Loopholes in the system
With the paper-based and hybrid system of maintaining data, workload is higher and storage need is bigger. The major disadvantages of paper-based and hybrid system data maintenance are:
More errors- Manual entry of patient reports are more prone to errors, which can be life threatening for the patient.
Loss of coordination- Coordination among specialists which is a must for SCI patient care can be easily lost either due to faulty data entry, misplacement or misinterpretation of the reports. The result can be devastating for the patient and the success rate of the rehabilitation center will be low.
Time consuming- Fishing out reports and records from bulky paper repositories is time-consuming and there is a greater chance of misplacing and losing vital information.
Reduced efficiency- With more time invested on writing down patient notes and reports, less time is dedicated to patient care.
What technology can offer?
Technology has always been a life-saver. The advancement of technology in rehabilitation processes is changing the course of how individuals with SCI take part in rehabilitation. Technology plays an ever-increasing part in decreasing the time expended for information collection and entry and more time can be spent for the patients’ care. This is where the Electronic Medical Report (EMR) system comes into play. The medical reports of a patient commensurate with the duration of care seeked by the patient. The usage of EMR covers data from registration and billing to laboratory, clinical data, progress report, follow-ups and pharmacy.
A great EMR system is beneficial both for providers and patients. The benefits provided by an EMR system are:
1. Administrative benefits
Smooth front-office operations- In hospitals, front office manual operations like scheduling an appointment and billing is a time-consuming affair. The implementation of an EMR system in the healthcare facility reduces the time and labour required for non-medical front office jobs, especially in a populous country.
Paperless and Fewer Storage – With the implementation of EMR systems, redundant paperwork can be eliminated and an eco-friendly environment can be maintained. Digital storage saves space. The storage space required to store bulky patient data can be productively used to generate revenues.
Financial profits- In an international scenario it was analyzed that healthcare providers could save up to 28% by reducing transcription costs, 2% improvement in billing capture and 78% by decreasing billing errors. By executing EMR system, there will additional reduction in cost of stationery items and labour cost.
- Physician support
Patient chart and care plan- The rehabilitation protocols and care plan are unique for each SCI patient depending upon the injury level and requirement of multispecialty care. A single platform containing all the history, diagnosis, treatment protocol, future strategies is both time-saving and life-saving.
Support team-based care- With a calling and chatting facility, the doctors and nurses can be in contact with each other and easily available when needed. Also, an app for hand-held devices makes life easier.
Reduce cognitive workload- Retrieval of old records are easy and less time consuming. The progress reports and remarks of each attending doctor and nurse can be easily accessed for reference.
Intra-operability and interoperability- Sharing of patient data and diagnostic reports within various departments of the healthcare facility and reports from different facilities becomes smooth.
Automatic data transmission – The patient reports and diagnostic results are automatically transferred to patient portal.
High efficiency and productivity – With methodical entry of comprehensive patient reports, clinical decisions can be made quickly. This increases patient safety and recovery rate. With increasing incidence of SCI in India and doctor to patient ratio, seamless data flow and recovery can help the doctors assist more patients.
- Patient Portal
Easy booking and payments- Scheduling appointments and payments can be carried out easily from the comfort zone of the patient. The patients receive immediate e-prompts to ensure that the required data is recorded.
Video Teleconsultation- Individuals with SCI are under a lifetime risk for secondary medical complications. Nothing could be better for SCI patients and their family when the doctors are just a click away. A video teleconsultation can reduce the travel stress for the SCI patients and their care-givers. The doctors too can explain the processes by sharing videos and notes. The care-givers, family or friends can also join the teleconsultation through guest links.
Facilitate patient engagement- Immediately after being discharged from hospital or rehabilitation centers, the patient cannot be back to his normal routine. Depending on the level of injury, the amount of workload is advised to the patient. It is required to keep the patient engaged for his physical and mental well-being. Virtual library is helpful where hospital curated videos can be sent to the patient. This helps to keep the patient engaged and is also beneficial for the recovery of the patient.
Provide e reports and e prescriptions- Detailed reports and prescriptions which can be printed can be obtained after the teleconsultation.
Increased preventive care- The patient portal keeps the patient and his care-giver in regular touch with the healthcare facility. This helps the doctor to check the patient regularly and prevent secondary complications.
EMR in Indian Scenario
In India the use of complete electronic health records is limited to few private hospitals such as Max Health, Sankara Nethralaya, Apollo, Fortis, etc. Major public hospitals like All India Institute of Medical Sciences (AIIMS) and the Postgraduate Institute of Medical Education and Research (PGIMER) use Electronic Medical Record (EMR) to maintain and share the patient data within the facility.
The Ministry of Health & Family Welfare (MoHFW) along with the Ministry of Electronics and Information Technology (Meity) has taken the initiative to digitize the healthcare system in the country and have submitted the draft on 24th April 2019. Guidelines issued for EMR standards and meta-standards are monitored by National e-Health Authority (NeHA).
Accordingly, all hospitals are looking forward to a digital bank to store the patient records.
With only 1.13% GDP allocated for the healthcare system the main challenge for implementation of EMR is funding, well-trained manpower and infrastructure. Also, the EMR interface must be easy to use. Most clinicians prefer an interface to which they can quickly adapt to and use without any hindrance.
Along with the implementation of EMR, it should be ensured that the technology used should be relevant and appropriate. Security breach in privacy and confidentiality of patient data creates a threat for the healthcare institution as well as the patient.
With about 60% SCI patients coming from economically weaker sections of the society most SCI patients opt-out of the rehabilitation due to its high cost. The high treatment expenditure for SCI can be reduced by implementing EMR and ensuring equal treatment for all. The easy availability of patient records helps hospitals to avoid repetition of tests and reports unless required. Approximately 79% of SCI patients are from rural areas. To get access to rehabilitation and regular care, travelling a long way or an arranged accommodation is an added expense.
The teleconsultation facility helps the patient to reduce cost due to longer hospital stay or arranged accommodation and travel costs. Implementation of the EMR framework for Indian health system will improve the work-flow of health services for the population. EMR at all levels of the healthcare system enables efficient and continuous care to the patient.
The inclusion of the EMR system in the healthcare system has yielded positive reviews from facilities and independent care providers all over the world. A competent EMR system increases the total productivity of the facility and results in positive financial return for the organization. With the high-quality care given to the patients, the recovery rate of the patients was high. High patient satisfaction highlighted the success rates of the facilities. Inclusion of EMR systems helps to maintain a transparency among the doctors and also with the patient.
A good EMR system is a great support in delivering quality care to SCI patients. With seamless flow of data within the clinicians, precious time is not wasted in hunting previous reports. More time can be dedicated to patient care than writing and hunting repositories for patient data.
This proves that EMR is a vital tool to upgrade the healthcare quality of the country. The current electronic medical record system provides “intra-operability” within the same healthcare organization or the various branches of a particular organization. The advancement of information technology provides a wider scope to improve the quality of healthcare and make it accessible to all. With the various government initiatives, interoperability between various healthcare providing organizations will soon be achieved. By following one standardized system, interoperability can be developed among all levels of health care.
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