Title: Electronic Medical Records in Indian Hospitals: An organizational goals

perspective

Abstract:
Globally, it has been demonstrated that Information Technology can improve
affordability, accessibility and patient outcomes of healthcare in a country.
Adoption of Electronic Medical Records (EMR) across hospitals is an important
enabler for IT-driven reforms in healthcare in India. EMR has improved the
quality of care provided by the hospitals in multiple ways ranging from easy
access and management of patient information to clinical decision support.

Research has clearly pointed out the various benefits of EMR in hospitals. But,
hospitals have faced a lot of issues in adoption and implementation leading to a
gap between espoused purposes and the actualized implementation.

We adopt a multiple case study approach to investigate the adoption of EMR in

four large hospitals in India. The data collection, which involved field visits and
in-depth interviews with the top management teams of each hospital, helped in
understanding their perspectives about the adoption of EMR, the challenges and
issues faced in the adoption process, and the organizational change management
processes.

Based on primary research and interviews with the key stakeholders, we

identified four different organizational goals for EMR adoption in Indian
Hospitals: Compliance, Documentation (Record Keeping), Efficiency and
Effectiveness. Compliance involves the implementation of EMR for adhering to
the legal and regulatory requirements, for example, a trauma care hospital
outsourcing patient data management to a third party for maintenance of
records. These hospitals require capabilities, such as maintaining a data
repository and possibly installation of IT for ancillary purposes like laboratory
and radiology.

Data management or record keeping purpose entails capturing clinical data and
other related data for retrieval at a later date. These hospitals seldom ‘make use’
of the data for enhancing the care delivery. The efficiency perspective entails
coordinating patient care through access of patient information internally, for
example accessing the investigation reports online in real time. Automating
procedures and defining standard roles and workflows improve efficiency. This
enables better patient management.

The effectiveness perspective involves making optimal use of the captured

information for informed decision-making, both managerial and clinical.
Incorporating rich information into clinical decision-making and quality
improvement improves the effectiveness of care.

Our research has wide implications for practice and theory. Rather than focusing
solely on the technology as an undifferentiated intervention, our study
emphasizes the role of goal-directedness in technology design and
implementation processes. The study identifies the various levels of adoption of
EMR and provides insights to the managers about the adoption of EMR and
delineating the process of implementation.

The research further identifies the facilitators and barriers in the EMR adoption
process in an Indian context, specifically differentiating the barriers on the basis
of the purpose of EMR adoption. The study contributes to the overall
understanding of hospitals in India and provides recommendations to improve
the success rate of EMR adoption, in specific.

Keywords: Electronic Medical Records, Implementation, Hospitals, India,

Organizational goals