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 Table of Contents  
EDITORIAL
Year : 2022  |  Volume : 5  |  Issue : 2  |  Page : 49-52

Digital clinical record management system for creating evidence-based Ayurveda practices


Director, All India Institute of Ayurveda, New Delhi, India

Date of Submission16-Jun-2022
Date of Acceptance21-Jun-2022
Date of Web Publication28-Jun-2022

Correspondence Address:
Prof. Tanuja Manoj Nesari
All India Institute of Ayurveda, Sarita Vihar, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jacr.jacr_51_22

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How to cite this article:
Nesari TM. Digital clinical record management system for creating evidence-based Ayurveda practices. J Ayurveda Case Rep 2022;5:49-52

How to cite this URL:
Nesari TM. Digital clinical record management system for creating evidence-based Ayurveda practices. J Ayurveda Case Rep [serial online] 2022 [cited 2022 Aug 13];5:49-52. Available from: http://www.ayucare.org/text.asp?2022/5/2/49/348698



Information and Communications Technology (ICT) seem to diffuse in almost all sectors. ICT has transformed the way health care data is managed. The widespread usage of electronic devices along with the availability of high-speed Internet has made possible the transition from paper-based patient records to electronic records. Implementation of information technology (IT) in health care is being accelerated to provide effective and better care for citizens of India.

Ayurveda has a unique hierarchy regarding teaching, training, and patient care. The ancient school works such as a Gurukul. The selected admitted students approach their GURU (teacher) directly and got the knowledge. As time passes, globalization and modernization are urgently needed to disseminate this traditional system of medicine. In the era of the artificial intelligence, the digitalization of Ayurveda in terms of the electronic medical record (EMR), electronic health records (EHRs), Healthcare Information Management System (HIMS), and other software-based technologies may play a unique role in clinical data management (CDM). The integration of ICT with Ayurveda has changed the perception of Ayurveda education, research, and the health-care system. National Commission for Indian System of Medicine (NCISM) advised to all its approved colleges to have their own websites for hospital data management.[1] This is the right time to introduce with existing digitalized data systems for Ayurveda Institution across the Nation to create evidence based databases.

A number of terms have been used to describe the move from paper-based records to electronic records. Automated health records were the term used for a set of health records stored in the form of images on a computer. These types of health records were used in the early 1990s when data were stored in the form of images on the optical disk. The Computer-Based Patient Record (CPR) was used to define a collection of health information for a single patient, either for a single episode or for an extended period of care and this was linked by a patient identifier. CPR focused on functions such as alerts, orders for medication, and providing integrated patient information from various departments such as pharmacy, laboratory, radiology, etc. However, the exchange of information was limited to inpatient facilities. The term EMR was used to define an electronic record system used by general practitioners to record patient clinical information such as identification, prescription, and laboratory test results.[2] EHRs were first introduced in the 1960s. In 2009, the “Health Information Technology for Economic and Clinical Health Act”[3] was passed and around $30 billion was allocated for the adoption of the EHR and its implementation on a large scale.[4]

CDM is involved in all aspects of processing the clinical data, working with a range of computer applications, and database systems to support the collection, cleansing, and management of subject or trial data. The primary objective of CDM processes is to provide high-quality data by keeping the number of errors and missing data as low as possible and gathering maximum data for analysis.[5] The design, execution, and analysis of clinical studies involve several stakeholders with different professional backgrounds. In the current global scenario, electronic case report forms (eCRFs) are a way for clinical data managers, researchers, and other clinical trial stakeholders to get better data in a faster way. ECRFs are preferred over paper CRFs as they are less time-consuming, and also encourage the sponsor/pharmaceutical company to carry out large multicentric studies at the same time due to the ease of administration. It is designed in such a way that data entry can be done with zero/minimal errors. Moreover, the regulatory authorities are readily accepting submissions in which validated Electronic Data Capture systems are used.

In health-care organizations, the EMR system is being used to capture, organize, maintain, and retrieve patients' medical records. EMR system consists of a comprehensive database used to store and access the patient's health-care information. In the beginning, there were only handwritten charts which were time-consuming and tedious. Illegible handwritten charts not only took a lot of time to undertake and interpret but also to more serious problems such as errors in diagnoses, treatment, and billing. The EMR has replaced the existing paper medical records as the primary source of information for health-care purposes for all clinical, legal, and administrative purposes.

The EMR system facilitates the interaction among specialists or initial attending doctors, patients, attendance of long-term care, and business administration such as risk management and billing. EMRs allow medical personnel to look at charts and histories of patients without having to search for paper-based medical reports. With the use of a document imaging system, cataloging can be done according to its specific need. Moreover, patients' charts can be customized according to the preference of the medical personnel. Besides that, it can also list the type of medication and dosage on a patient's file. SimplePractice™,[6] NextGen® Office,[7] TheraNest,[8] TherapyNotes™,[9] WebPT,[10] etc., are some of the important EMR management systems that are being used in various hospitals, health centers, clinics, etc. Nowadays, EMR systems are widely used in hospitals, nursing facilities, health care clinics, laboratory facilities, treatment centers, and physician's offices. Once the medical records are in electronic form, in various operations the basic functions of HIMS would become very easy.

EHRs are also in use to manage the data of the patient. EHR refers to a real-time, unique longitudinal health record of a single individual containing the entire personal health information of the patient including medical details such as history, medical examination, diagnosis, laboratory results, allergies, details of immunization, and treatment in a digital format. It is important to note that EHR differs from EMR. EMR is a digital version of paper record related to patient's medical history recorded in a clinician's office. EMR is not designed to be shared outside an individual clinical practice. On the other hand, an EHR is a comprehensive report of an individual's overall health. EHR is a collection of various medical records. It is designed with an intention to be shared outside the healthcare organization. The Ministry of Health and Family Welfare (MoH and FW) first came out with standards for EHR for India in September 2013. These were based on the recommendations made by the EMR standards committee constituted under the MoH and FW.[11] The document contained recommendations for developing a uniform system for EHRs creation and maintenance by health-care providers. These standards were revised and were notified in December 2016.[12]

India's digital health policy advocates the use of digital tools for improving the efficiency and outcome of health-care system and lays significant focus on the use of telemedicine services, especially in the health and wellness centers at the grass-root level wherein a mid-level health-care provider/health worker can connect the patient to the doctor through technology platforms for providing timely and best possible care. It is far easier to set up an excellent telecommunication infrastructure in suburban and rural India than to place hundreds of medical specialists in these places. We have realized that the future of telecommunications lies in satellite-based technology and fiber optic cables.[13] In India, telemedicine programs are actively supported by the Department of IT, Indian Space Research Organization, NEC Telemedicine Program for North-Eastern States, Apollo Hospitals, Asia Heart Foundation, and many state governments.

CCIM has released telemedicine practice guidelines for Ayurveda, Siddha, and Unani practitioners to make ASU practitioners able to use the telemedicine tools, for example, telephone, video, and devices connected over LAN, WAN, Internet, mobile, etc. Telemedicine practice can prevent the transmission of infectious diseases to both doctors and patients by avoiding social contact. Telemedicine had been an ideal option for COVID-19 situations allowing all channels of communication that leverage IT platforms, including voice, audio, text, and digital data exchange to help in diagnosis, prescription, and follow-up evaluation.

Patient safety and care in a health-care practice is a top concern that doctors, nurses, administrators, and staff aim to improve every day. Over the past few decades, there have been incredible advancements in patient safety, due in part to better technology. One technology that has had a tremendous impact is the barcode. In addition to increased patient safety and identification, this technology offers many other benefits, including improved operational efficiencies. Health-care barcode solutions help streamline the patient admittance process, track medication and care admission, and identify patients throughout their entire stay. Barcode wristbands are typically created at the point of admission, and specific patient information is continually updated based on the patients' needs. The barcode technology makes sure the correct treatment is administered to the right patient, ultimately reducing errors, and ensuring patient safety.

The Digital India movement initiated by the Government of India has made significant changes in the IT sector. Implementation of IT in health care is being accelerated to provide effective and better care for citizens of India. Health Management Information System (HMIS) is a government-to-government web-based monitoring information system that has been put in place by MoHFW, the Government of India to monitor the National Health Mission, and other health programs and to provide key inputs for policy formulation and appropriate program interventions.

The Ministry of Ayush has taken initiative to get onboard in health-care IT implementation projects. In this regard, the Ministry of Ayush has created AYUSH Grid, a mega digital platform for connecting all AYUSH-related institutions/hospitals as well as the new hospitals to be developed under this umbrella and all other such institutes/units which are directly or indirectly benefitted/associated with it to generate various types of data for the requirement of information gathering, sharing, and further processes, which is an urgent need of the hour. It is an integration of IT projects exclusively meant for the improvement and facilitation of AYUSH pan India. In continuation to digital India initiatives taken by the AYUSH sector, certain initiatives at the national level such as Traditional Knowledge Digital Library (TKDL), AYUSH Health Management Information Systems (A-HMIS), National AYUSH Morbidity and Standardized Terminologies Electronic Portal (NAMASTE Portal) are paving the way for improving research and practices. Deployment of the AYUSH Sanjivani application to collect millions of users' data on AYUSH practices during the COVID-19 pandemic demonstrated the responsiveness of the digital initiatives to an emerging situation.

The A-HMIS is being implemented nationwide in all AYUSH hospitals of research councils and its national institutes. The effective implementation of A-HMIS has created a tracking database of AYUSH beneficiaries by replacing the old and time-consuming paper-based system. All India Institute of Ayurveda, New Delhi, an autonomous institute under the Ministry of Ayush has also developed an integrated hospital management system which gives complete solutions under one roof. It has 24 modules such as queue management system, outpatient department and in-patient department (IPD) management, pathology, pharmacy, panchakarma, diet, yoga, and many other supporting modules. This system has been designed to maximize the accuracy of data, handle the patients, and provide error-free reports and paperless facility. It also intends to change the whole hospital system from manual to computerized and to maximize work efficiency. The software has the ability to give a unique id for all patients and has the search capability for the availability of IPD rooms and allots time slots for procedures of Panchakarma and Kriyakalpa based on the availability. The data can be retrieved easily with a user-friendly search interface. Data are also well protected. In future, there is larger scope for the implementation of technologies such as artificial intelligence (AI) in integrated hospital management systems where these technologies can perform in par with humans while diagnosing disease or precision medicine, i.e., predicting what treatments would succeed based on patient attributes.

The centralized database of unique morbidity codes for the AYUSH system of medicine has streamlined the classification of diseases and standardized the diagnoses. In this context, the NAMASTE portal was established and it has a database of morbidity codes for all AYUSH systems. The NAMASTE portal brought unique codes for all the diseases using ICD codes.[14] Recently, many critiques have expressed that traditional systems do not have sufficient scientific evidence for treatment and poor in documentation of patient data.[15] There is no exclusive database to store and retrieve the AYUSH systems-related research articles. The AYUSH research portal and DHARA are two significant and much-needed initiatives to fulfill this gap.

The international community and the developed countries have established a number of clinical trial data management regulations and technical guidelines to ensure the quality of the test data. The current national strategic plan of building an innovative society requires special programs and major new drug clinical trial data management standardization made more urgent needs. IT can be seen as one of the promising tools in providing a new way of creating evidence-based Ayurveda practice. As the implementation and utilization of technologies are very minimum in the practice of Ayurveda, the need of the hour is to design and develop cost-effective applications with the involvement of the actual user and also to disseminate the benefits and availability of these to the institutions practicing and promoting Ayurveda.



 
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2.
World Health Organization. Regional Office for the Western Pacific. Medical Records Manual: A Guide for Developing Countries. WHO Regional Office for the Western Pacific; 2006. Available from: https://apps.who.int/iris/handle/10665/208125/. [Last accessed on 2022 May 18].  Back to cited text no. 2
    
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Gerritsen MG, Sartorius OE, vd Veen FM, Meester GT. Data management in multi-center clinical trials and the role of a nation-wide computer network. A 5 year evaluation. Proc Annu Symp Comput Appl Med Care 1993;659-62.  Back to cited text no. 5
    
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Ozair FF, Jamshed N, Sharma A, Aggarwal P. Ethical issues in electronic health records: A general overview. Perspect Clin Res 2015;6:73-6.  Back to cited text no. 11
[PUBMED]  [Full text]  
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Dasgupta A, Deb S. Telemedicine: A new horizon in public health in India. Indian J Community Med 2008;33:3-8.  Back to cited text no. 13
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Ministry of AYUSH. National AYUSH Morbidity and Standardized Terminologies Electronic Portal. Available from: http://namstp.ayush.gov.in/#/index/. [Last accessed on 2022 May 28].  Back to cited text no. 14
    
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Patwardhan K, Tillu G, Jadhav PM. Good practices of publishing AYUSH research: A practical checklist for authors. J Ayurveda Integr Med 2017;8:132-6.  Back to cited text no. 15
    




 

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