Institut Jantung Negara (National Heart Institute or IJN) in Malaysia has reached a significant milestone by becoming the first hospital in the country to receive Stage 6 validation from the HIMSS Electronic Medical Record Adoption Model (EMRAM). This achievement marks a pivotal step in IJN’s digital transformation journey, showcasing its advanced adoption and maturity of electronic medical record (EMR) capabilities.
IJN’s Background and Initial Challenges
Establishment and Growth
Established in 1992, IJN is the largest cardiac hospital in Malaysia, boasting 433 beds and over 2,700 staff members. Each year, the hospital treats more than 300,000 outpatients with cardiac, thoracic, and vascular disorders. Despite its size and specialized focus, IJN faced numerous challenges in digitizing its records over the past 25 years. The road to complete digitization was met with complex hurdles, beginning with the integration of existing systems and managing the transition for the entire organization. These obstacles put a strain on resources and tested the resilience of the hospital’s management and staff.
Early Attempts at Digitization
The journey towards digitization began in 1998 when IJN acquired the MedTrak hospital information system. However, over the next two decades, the hospital struggled to implement an organization-wide EMR system effectively. A major impediment was change management, particularly gaining physician acceptance for MedTrak and its upgrade, TrakCare, in 2009. According to Dr. Alwi Mohamed Yunus, IJN’s Clinical Director of Health Informatics, the hospital found inadequacies in clinical documentation, which hindered progress. Many workers were resistant to change, viewing the additional data entry as burdensome rather than beneficial, causing friction and slowing down potential advances.
Overcoming Setbacks and Achieving Digital Successes
Challenges with External Vendors
In a subsequent attempt to implement an EMR system with an external vendor between 2021 and 2023, IJN again faced challenges. This project failed due to a lack of cohesion between the primary vendor and the hospital’s implementation partner, leading to its termination in March 2023. Despite these setbacks, IJN managed to achieve some digital successes over the years. The hospital had to regroup, analyze what had gone wrong, and devise a new strategy that could accommodate their unique needs while smoothing over previous problem areas. This phase was critical to laying the groundwork for a more unified and forward-thinking digital transformation.
Key Digital Milestones
In 2009, the hospital introduced PACS (picture archiving and communication systems), and by 2010, it began the computerized physician order entry (CPOE) of medications at outpatient clinics. Additionally, the hospital started to generate electronic records, such as initial doctor’s consult notes, operative notes, and discharge summaries, through its Clinical Research Database starting in 2014. Hospital management played a crucial role in supporting staff to learn new skills necessary for these digital transformations. They ensured ongoing training programs to bridge any skills gaps, thus maintaining staff engagement and promoting a smooth transition to more advanced systems.
Strategic Planning and Alignment with HIMSS
Forming a Comprehensive Methodology
Despite achieving isolated successes, IJN remained committed to fully digitizing its operations. The hospital sought a comprehensive methodology for transforming the organization. The opportunity came in early 2023 when HIMSS signed a memorandum of understanding with the Malaysia Healthcare Travel Council (MHTC) to promote hospital digital transformation in the country’s healthcare travel industry. IJN, already aiming to secure MHTC Flagship Hospital status, which required HIMSS EMRAM validation, found this alignment beneficial. The synergy between these initiatives and the hospital’s own goals provided a robust framework for driving forward their digital agenda with renewed energy and focus.
Implementing the Build-Buy Strategy
Starting with a baseline assessment of its EMR maturity in November 2023, IJN focused on meeting EMRAM requirements by forming a hospital-wide working group and appointing an IT consultant. The hospital opted for a build-buy strategy to ensure its system complied with HIMSS standards, using paper forms as templates for functionality and purchasing a clinical documentation engine for compliance with international standards such as CMV, LOINC, and SNOMED. This hybrid approach positioned IJN to leverage existing knowledge while acquiring state-of-the-art technological tools, maintaining both the practical and innovative aspects needed for substantive digital progress.
Achieving Stage 6 Validation
Role of IT Experts and Reengineering Work
This strategy was supported by IJN’s team of IT experts, including skilled in-house programmers and application specialists led by Fariz Zaki and Suriyani Azaman. There was significant reengineering work to set up the CPOE of medication and allied health services and implement closed-loop, technology-enabled systems for blood products, human milk, specimen collection, and medication administration. Their expertise and dedication were pivotal, transforming theoretical plans into operational realities, and revealing the true potential of teamwork in achieving healthcare technology milestones.
Demonstrating Compliance and Core Modules
By focusing on the standards and compliance elements essential for Stage 6, IJN could prioritize core modules and assign tasks with specific timelines effectively. During HIMSS validation, IJN demonstrated its closed-loop system for blood product administration, iBlood, which has helped the hospital achieve zero blood transfusion errors since its introduction and is currently adopted by 96% of clinical users. This comprehensive compliance showcased not only their technical proficiency but also their commitment to patient safety and operational excellence, reinforcing IJN’s esteemed position within the healthcare sector.
Looking Forward to Stage 7
Future Goals and Collaboration
Looking forward, IJN aims to achieve the highest EMRAM stage—Stage 7. Dr. Rhema Sundram, IJN’s Head of Customer Experience and EMRAM Clinical Sponsor, expressed hope that technology partners would be more inclined to collaborate with IJN due to its ability to offer better patient safety, experience, and staff satisfaction through technology-enabled services. The hospital’s ongoing pursuit of technological enhancement serves not merely as an operational strategy but as a beacon attracting collaboration and innovation opportunities from global industry leaders.
Importance of Organizational Cohesion
This notable accomplishment signifies a major step forward in IJN’s ongoing digital transformation process. By reaching this stage, IJN demonstrates its advanced capabilities and maturity in the implementation and use of electronic medical records (EMR). The recognition by HIMSS underscores the institute’s commitment to enhancing patient care through technology. Such an achievement places IJN at the forefront of healthcare innovation in Malaysia, setting a high standard for other medical institutions in the country. This milestone not only benefits the hospital but also improves the overall patient experience, making healthcare delivery more efficient and effective. It highlights IJN’s dedication to integrating cutting-edge technology into everyday medical practice, which is essential for the future of healthcare.
