Monday, October 18, 2010

Why don't Indian doctors use EMRs ?

Why do Indian doctors continue practising in exactly the same way their seniors did 40 years ago ?

A major lacuna is the poor quality of medical records which most doctors keep. The medical record is the heart of clinical care - and yet it's extremely poorly maintained in Indian clinics today. The majority of doctors do not even bother to store and keep their patient's medical records - they just write down their opinion on their letterhead and hand it over to the patient. Usually, this is just a laundry list of tests the patients needs to do and a hand written illegible scrawled prescription - without even a mention made of the clinical findings or what the diagnostic impression is ! While it's good that the patient owns his own records, what happens if the patient forgets to get his records for the next visit ? This creates a lot of frustration for the doctor, who berates the patient for his carelessness - but the damage is done ! Wouldn't it make much more sense to keep a copy - and give one to the patient if he wants it ? Is this a lot of hard work ? Not anymore ! In the old days, one would have to make carbon paper copies or provide xeroxes, but using electronic medical records, this is now very easy to do !

Clinical care protocols are very similar in the US and in India. This is hardly surprising - after all, patients are the same the world over , and most will need the same kind of treatment. However, while most Indian doctors will provide exactly the same standard of medical care a doctor in the US does, why is there such a big difference in the way they keep medical records ?

In the US, every medical encounter is carefully documented ! Perhaps this was originally done for protecting against lawsuits for medical negligence; but today, the US government is making it compulsory for all US doctors to use EMRs - not just to improve the quality of care, but also to reduce costs ! Why don't Indian doctors use exactly the same approach to documenting their clinical care ? Are they too busy to do so ? too lazy ? or do they feel it's not important enough ?

Why do most doctors in India not bother to document their clinical encounters well ? Why is medical record keeping still shoddy and badly done in most practises ?

If Indian doctors understand the clinical importance of keeping good quality medical records, then why are they so reluctant to use EMRs ( electronic medical records ) ? In the past, it was true that PCs were very expensive; and that few doctors would afford them. Also, many older doctors were not very computer -literate; and the software programs which were available for medical record keeping were very doctor-unfriendly ! A combination of computer-unfriendly doctors and doctor-unfriendly software meant that most doctors were quite disillusioned with EMRs and were not willing to use them.

The good news is that things have changed dramatically ! Technology has improved; computers have improved; and Indian medical software companies such as Plus91 ( in which I am an angel investor) are realising the importance of mapping the doctor's clinical processes and respecting his work-flow so they are now making EMRs which are doctor-friendly and which enhance his productivity !

So why aren't Indian doctors rushing out to buy these , given the fact that they are inexpensive and can help them to improve the care they provide to their patients ?

Partly, this is because of the unhappy experiences doctors have had with Indian medical software in the past. It was the computer-savvy early adopters who were the first to lump on the IT bandwagon 10 years ago, to try to use computers to improve clinical care. Unfortunately, they burnt their fingers, which is why they are reluctant to try again.

As a consequence, most doctors do not know any one else who is using EMRs; and because they have little exposure to practise management skills during their training, they still do not understand the value an EMR can provide to their life.

Another major problem is that Indian doctors are not willing to pay for this. This is because they have been completely spoilt by the pharma companies . Because they are so used to getting everything free from pharmas, they are not willing to pay for anything at all ! This means EMR companies find it hard to sell their products - but if they do not generate revenue, how will they be able to produce good software ?

Please remember that your patients form the heart of your practise - and your patient's medical records are worth their weight in gold. If you keep them carefully; update them religiously; and share them with him, you can show your patient that you have all his medical details on your fingertips. This will help to inspire confidence in your clinical skills . Patients will rave about how well-organised you are - and this word of mouth marketing will help you get more patients, as it differentiates you from other doctors.

Also, by keeping your patient's records, you are creating a lot of patient loyalty and "stickiness" . If your patient is confident you know all about him because you have all his medical details, he is going to be very reluctant to switch doctors - after all, who wants all the hassle of explaining his medical history all over again to a new doctor ?

However , if you do not keep your patient's records; and the patient has to start explaining everything which has happened to him every time he sees you, be is likely to lose confidence in you very quickly ! ( That doctor does not even remember my name - forget about my medical problems !)

Hospitals in India have started documenting medical care electronically; and boutique medical clinics and chains have also started doing so. This is very heartening progress - and doctors who do not start doing so soon are going to find they will start losing their patients to computer-savvy doctors ! You need to move with the times - or you will get left behind !

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  1. Nice post! Now I know Why don't Indian doctors use EMRs? Thanks for sharing this post. I enjoyed reading it. Keep posting.


  2. Shouldn't the government hospitals start this practice? Everyone else will follow.

  3. The World is going paperless, and here RSBY Insurance companies want us to go back from Electronic medical records to physical paper hard copy records, inspite of having a fully authenticated,secure total paperless system of EMR with ICD 10 coding in our rural hospital, or they threaten us with de-empanelment.
    Isn't it a retrograde step?
    Why doesn't IRDA and government comes out with clear guidelines

  4. Dear Dr. Malpani,

    You have very rightly pointed out the reasons why the doctors today stick to the same methods which have prevailed since decades. The technological advancement in field of equipment and treatments fascinates them, but when it comes to EMR they prefer backing out.

    EMRs exist in India since very long; still more than 70% of the medical fraternity use it for maintaining their appointments only. They prefer writing the prescriptions on their letter heads. Even big private hospitals are not able to use EMR to manage all their patient records like the operative summaries, detailed diagnosis, daily charts for indoor patients. Lot of things are still done using paper. And the patient has to carry all of them in every visit.

    I myself have experienced this when my mom-in-law was undergoing treatment for cancer. Her complete treatment was done at one the best private hospital of Vadodara (an ISO 9001:2008 institute). For three long years, we carried all her documents X-Rays, Operation details, CDs (almost 3 bags full) wherever we got her admitted for further treatment. The hospital authorities never referred to their EMR records and they always asked us to present the required report. Whenever there would be an emergency to take her to the hospital, we had to run looking for her medical records first; we knew that would be the first thing we would be asked for.

    I always wonder how to doctors treat patients who come from far off cities, what if they don’t carry their documents, and can that lead to wrong treatment?

    In 2010, before launching our product in the same domain we did a survey across Doctors running their own private hospitals in Vadodara and we found few more interesting facts that do not let them go for a complete automation. The lack of tech-savvy staff is one such prominent reason. Even if they manage to train the staff, it’s tougher to retain such a talent. Once the person leaves the job they just don’t have any way to refer to their records so they feel comfortable in their traditional methods of record keeping. Most of the doctors are themselves not tech savvy and its gets difficult for them to get used to the EMR, moreover they are not able to judge whether the EMR has all the features that they need. The EMR UI is just not user-friendly or intuitive enough for people to be able to operate through it. And when a doctor is flooded with patients, he hardly has time to look for the right option in the EMR.

    We at PurpleDocs aim at bridging few of the above mentioned gaps and enable the medical fraternity to maintain their patient records without changing the way they work. Doctors can enrol for our service without have to pay anything. They can pay as they use our service. The software does not need any installation; the doctors can carry all their records in the form of a searchable database in a CD or USB and can run it on any PC. We also provide access to their records online. We digitize the paper based records and tag all the records (X-Rays, MRI, Bills, Reports, CD) on customised tag fields chosen by the doctor. We have laid special emphasis on making the UI simple enough; it’s as easy accessing your e-mails. We have been providing this service from last 1.5 years to more than 20 hospitals across Vadodara. We are planning to expand our service soon to other parts of the country. You can find out more about us from our FAQ page (

  5. The question is 'are there any "good" EMR software solutions available for Indian doctors need' ? If there are, please someone post few of them here for the benefit of all. If there are none, and if someone needs one how can we know what is the demand there.

    Nice post by the way.

  6. Hello Mr Malpani..i appreciate your findings about the Indian healthcare system. Presently i am working on a research report on the North America healthcare IT market. While this study i am understanding the insights and the vast impact of healthcare IT on healthcare delivery. I see India as a growing market for the healthcare IT with a CAGR of more than 23%. I am a MBA hospital and healthcare management graduate from symbiosis, pune and want to work for healthcare IT adoption in India...kindly contact me if we can work togather.

    [email protected]
    +91 9028165232

  7. Anonymous2:36 PM

    Sir please provide the list of companies who provides or who develope the EMR and EHR sofware . So that i can use in my hospital as u said.plz reply fast


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