In a country first, Institut Jantung Negara (National Heart Institute) in Malaysia has been recently validated for Stage 6 of the HIMSS Electronic Medical Record Adoption Model.
The EMRAM measures an organisation’s adoption and maturity of their EMR capabilities.
Founded in 1992, the 433-bed public quaternary hospital sees over 300,000 outpatients with cardiac, thoracic and vascular disorders each year, served by a staff of over 2,700. It is the largest cardiac hospital in Malaysia.
A 25-year journey
Its digital record journey began in 1998 with the acquisition of the MedTrak hospital information system.
For over two decades, IJN faced difficulties in successfully rolling out an organisation-wide EMR system. One particular challenge was change management.
“We were unable to make much headway with physician acceptance of MedTrak or its upgrade, TrakCare, in 2009, finding inadequacies in clinical documentation,” said Dr Alwi Mohamed Yunus, IJN clinical director of Health Informatics.
“We attempted to implement an EMR rollout with an external vendor in 2021-2023 but this also failed due to a lack of cohesion between the primary vendor and our implementation partner; this project was terminated in March 2023,” he added.
Despite these failures, there were also some successes, Dr Alwi noted. “We were able to implement PACS in 2009, we had begun CPOE of medications at our outpatient clinics in 2010, and we had the beginnings of electronic records (initial doctor’s consult, operative notes and discharge summaries), which were generated through our Clinical Research Database in 2014. The digital records were initially within the Cardiac Surgery Department, and were later expanded to PaedsCare, the Paediatrics and Paediatric Surgery database.”
Hospital management gave its full support to staff in learning new skills. “In this sphere, change management has to be not only clinician-led but senior clinician-led,” Dr Alwi emphasised.
First Stage 6 EMRAM in Malaysia
While IJN achieved “isolated successes” in digitising some of its processes over the years, it was still determined to digitally transform the entire organisation. “We were in search of a methodology that would enable us to enact holistic change across the organisation,” Dr Alwi said.
In early 2023, HIMSS signed a memorandum of understanding with the Malaysia Healthcare Travel Council (MHTC) to develop the country’s healthcare travel industry by promoting hospital digital transformation. Coincidentally, IJN was already looking to secure the MHTC Flagship Hospital status, which requires a HIMSS EMRAM validation. “It was a happy coincidence that we were also planning to make the same journey [with MHTC]. HIMSS EMRAM provided the methodology for us to do so,” Dr Alwi shared.
After getting a baseline assessment of its EMR maturity in November 2023, IJN worked on fulfilling the EMRAM requirements. First, it formed a hospital-wide working group focused on the digital maturity validation and appointed an IT consultant.
To ensure its system was compliant with the HIMSS standards, the hospital adopted a build-buy strategy. “We built most of our functionality using our paper forms as templates. We had a buy strategy for our clinical documentation engine in order to have CMV, LOINC, SNOMED compliance,” Dr Rhema Sundram, IJN Head of Customer Experience, explained.
This build strategy, Dr Rhema said, was made possible by IJN’s team of IT experts, including skilled in-house programmers and application specialists led by Fariz Zaki and Suriyani Azaman.
A significant amount of reengineering work was also done to set up the CPOE of medication and allied health services, along with the implementation of closed-loop, technology-enabled systems for blood products, human milk, specimen collection, and medication administration.
“By staying focused on the standards and compliance elements that are required for Stage 6, we were able to divide our efforts to focus on core modules and assign tasks within modules with specific timelines to achieve these tasks,” Dr Rhema said.
During the validation, IJN demonstrated iBlood, its closed-loop system for blood product administration. Since it was introduced, the system has helped the hospital achieve zero blood transfusion errors. It is currently adopted by 96% of clinical users.
IJN is now moving forward to achieve the highest EMRAM stage. “We hope that our technology partners will be more inclined to work with us to achieve Stage 7 validation as they can bring potential clients to IJN to evaluate how a technology-enabled cardiac hospital is able to offer
better patient safety and experience, and deliver staff satisfaction and work efficiency too,” appealed Dr Rhema, who is also the hospital’s EMRAM Clinical Sponsor.
ON THE RECORD
“I do not think we could have made this journey without having the EMRAM guide us to the critical elements and the elements that can be deferred. What we have learned is that the hospital works like a Swiss watch: it has many moving parts that must interact with each other in order to function accurately and smoothly. The EMRAM methodology allowed us to say, ‘We intend to implement that, but it’s not required yet for Stage 6 validation, and then move on to the more pressing tasks that were essential.”
Professor Dato’ Sri Dr Alwi Mohamed Yunus
Clinical Director of Health Informatics
Senior Consultant Cardiothoracic Surgeon
EMRAM Program Leader
IJN
“What we have learned about digital transformation is it’s less about the system you choose but more about the organisation coming together as one cohesive team with a shared goal.”
Dr Rhema Sundram, Head of Customer Experience, EMRAM Clinical Sponsor, IJN
