Even as Tamil Nadu boasts of the best government healthcare infrastructure, there is zero digitization of medical records of patients in any of the government hospitals leading to serious lapses in treatment often leading to dire consequences for thousands of patients.
In December 2018, the state woke up to a horrific case of medical negligence in which a Sattur Government Hospital infused a pregnant woman with blood from a HIV positive patient. This glaring error happened despite the patient informing the Sivakasi blood bank of his condition.
This serious lapse could still take place in Chennai and even at the Rajiv Gandhi Government General Hospital (RGGGH) here as there is no facility to digitally track medical records of patients in any of the government hospitals here.
According to top health officials, the state health department under the Directorate of Public Health maintains only records of delivery cases, post-mortems and statistics of birth and death cases. However, even these records are maintained manually and automated records on computerized basis are not yet available to any of the government hospitals for tracking purposes.
Only manual medical records
The registration of patients and prescription details are only recorded in manual reports, while the treatment given to the patient, discharge summary and abstracts are not recorded because of the large number of patients seeking treatment at government hospitals in the city.
The government hospitals even fail to maintain records of cases of epidemic outbreaks and communicable diseases which points out to the major lapses as there is no facility to track these patients and provide follow-up treatment.
“We approximately have more than 20,000 case sheets to maintain on a single day at a district headquarters medical college and hospital. To maintain these case sheets at all government hospital and to track them on an everyday basis cannot be done manually as it would require a greater number of staff members and storage facilities,” said Director of Public Health Dr K Kolandaisamy.
Currently, we are not in a position to maintain a comprehensive record of all the medical cases in the government hospitals across the State. There are hospitals with bed side laptops and nurse stations equipped with laptops to maintain every bit of treatment procedure and thus, maintain records. We need such an infrastructure and storage ability to maintain all the records,” added Dr Kolandaisamy.
With inaccessible records, Patients suffer during follow up treatment
Without the medical records, government hospital patients have often been administered incorrect medicines and forced to repeat tests.
A few months ago, Sangeetha (23), a resident of Ekattuthangal, had been admitted at the Rajiv Gandhi Government General Hospital (RGGGH) here for a spine-related ailment and received treatment for over a month. When she was discharged, doctors handed out a bundle of paperwork (treatment details) for future reference.
“A few weeks later, Sangeetha fainted in a public place and was rushed to the RGGGH again. But, the doctors present in the casualty had no record of her past treatment and could not diagnose her ailment as her treatment history was not available with them leading to serious lapse of time in beginning treatment as all the tests had to be done again,” said a close friend of the patient.
Since the young woman’s condition wasn’t life threatening, she managed to get better. But, in several other cases, the absence of digitized patient history and the consequent delay in diagnosis has led to loss of life.
It’s not just the hospital wards, but even government blood banks, radiology centres and primary health care centres are unequipped with a digital platform to maintain medical and clinical records of any patient which often lead to serious lapses in treatment of patients.
Dinesh Kumar (23) from Pullianthopu was admitted to a government hospital in the city after he met with an accident. The medication given to the patient, instead of helping him recover, actually worsened his condition as the youth was allergic to some of the medicines.
The kin of the patients who arrived later claimed that Dinesh had been admitted to the same hospital four months ago when they discovered that he was allergic to a particular medicine given to him.
While patients’ kin contended that the doctors were aware of the side effects of the medicine and the patient’s medical history, doctors said that they did not have any handy medical records to refer and the patient’s medical history could not be analysed immediately as he was brought in a state of emergency.
In another instance, 43-year-old Rajeshwari underwent out-patient treatment for partial paralysis due to a neurological disorder at a leading government hospital in the city. There were various diagnostics tests performed for Rajeshwari that included screening tests including X-ray, MRI scan and pathological tests. She would come for follow-up visits every month.
But, when she accidentally misplaced her medical reports and reported the same, the doctors asked her to perform the tests and scans again. As Rajeshwari had already applied for the scan procedures under the Chief Minister’s Comprehensive Health Insurance Scheme for the same tests earlier, her application was rejected, and she had to shell additional money on her diagnostic reports as the hospital did not have a copy or the originals of her medical reports.
Similar cases of negligence have even reached the courts in the past. In 2012, a couple from Old Washermanpet claimed that a sanitary napkin was left in the abdomen of the woman after she underwent a C-section performed at a hospital in the city. The couple moved to the Commissioner of Police demanding compensation in the case. However, the hospital authorities denied the allegations but could not produce treatment records in the absence of automated medical records as the women was treated several years ago. The case has been in the Court for more than five years now.
‘Automated digital system is the need of the hour’
According to senior health officials, the records of patients in government hospitals are maintained manually with the Medical Records Department of the respective hospital. However, the manual records remain inaccessible to the patients for further treatment records. The numbers are converted to district wise data as numbers instead of individual patient data when reported to higher authorities. “Thus, an automated digital system is the need of the hour to enable individual specific treatment and follow-up records,” said a senior official.
The Directorate of Medical Education is moving towards the automation of the records with admission procedures being proposed to be moved online. However, this process remains only in the planning stage and is yet to be modified completely to automated mode. The Directorate of Medical Services however maintains computerised records.
Maintenance of online records in private hospitals and other states
Various private hospitals in the State maintain paper-less medical records that are stored with the hospitals for later referral and use by the doctors. Apollo Hospitals, Fortis Malar, MIOT International and other private hospitals in the city maintain electronic medical reports platform to network all the hospitals, diagnostic service centres and pharmacies to enable a patient to go paperless from admission of the patient to the hospital to rehabilitation process at their home to ease follow up process.
The Odisha government through its Odisha e-hospital management information system provides an online platform for recording clinical records. The system allows the patient to register and view or download their digital medical records through the web portal or a mobile application.
Not just Odisha, but also Haryana government has a system of computerised health records of the patient through health cards linked with their Aadhaar. The health card enables the doctor to access the patients’ medical history using the unique health identification number, while the patient can receive a hard copy of the medical history also. Though patients are provided with a unique ID number in Tamil Nadu, the records are only in paper and are not readily accessible to doctors or the patient unless there is any legal issue associated with the same.
Health dept to take to digital platform soon
Speaking to DT Next, TN Health Secretary Beela Rajesh said that the state health department is considering the move to online platform in government hospitals soon. “We are developing a system to maintain the records of the patient online to ease the accessibility of the medical records for the patient and the doctors. We will launch it soon,” said health secretary Beela Rajesh.
Responsibilities of an ideal medical records department
Medical Records Department maintains the set of documents containing the clinical, para-clinical care, and financial information about an individual patient. The MRD should not only collect and store patient information but also use it to promote the quality of patient care based on a regular analysis. The major roles of an ideal Medical Records Department include:
The MRD should record the registration of inpatients and outpatients who are admitted to hospital wards and emergency wards at the hospital
The records should ensure that a complete discharge summary and reports are recorded and organized and filed in an orderly and timely manner to be able to retrieve the records later for further treatment and the provision of other services
The collective case records should be used for preparing statistics for administration, improving quality patient care, hospital wards, and for submission to higher authorities such as State Health Department and Ministry of Health
The medical records of all the inpatients should be recorded following the discharge and assigned a unique numeral to classify the case and enable analysis of case eports at a regular interval
Medical and health facilities in TN
- About 6.5 lakh out-patients and 70,000 in-patients are treated in these facilities every day
- Government medical colleges - 22
- Primary health centers - 1,806
- Hospitals attached with the medical colleges - 48
- District headquarter hospitals - 29
- Taluk and non-taluk hospitals - 273
- Health sub centres - 8,706
- Urban primary health centers - 460
- New community health centres - 15
- Indian system of medicine hospitals - 1,491
- Multi-specialty hospital - 1
- Dental hospital - 1