Institut Jantung Negara (National Heart Institute, IJN) in Malaysia has recently achieved a significant milestone by being validated for Stage 6 of the HIMSS Electronic Medical Record Adoption Model (EMRAM). This accomplishment marks the first time a hospital in Malaysia has reached this level of maturity in electronic medical record (EMR) capabilities, signifying a major step forward in the country’s digital healthcare journey. This achievement highlights IJN’s commitment to enhancing healthcare through technological advancements and represents a pivotal moment in Malaysia’s healthcare transformation.
A 25-Year Journey Towards Digital Transformation
Early Beginnings and Initial Challenges
Founded in 1992, the Institut Jantung Negara (IJN) quickly established itself as the largest cardiac hospital in Malaysia, boasting 433 beds and employing over 2,700 staff members. Serving over 300,000 outpatients annually, IJN has been at the forefront of treating cardiac, thoracic, and vascular disorders. The journey towards digital transformation at IJN commenced in 1998 with the acquisition of the MedTrak hospital information system. Initially, the transition towards a more digital approach faced numerous obstacles. One prominent challenge was change management, particularly the acceptance of the system by physicians, which proved to be difficult.
Despite implementing MedTrak, the hospital struggled with system upgrades and received pushback from the clinical staff. In 2009, an upgrade introduced TrakCare, which proved inadequate for clinical documentation needs, resulting in further resistance from physicians. Efforts to develop an EMR system with an external vendor between 2021 and 2023 also failed due to a lack of cohesion between the primary vendor and the implementation partner. This led to the project’s termination in March 2023, highlighting the complexities and challenges involved in achieving a fully digital system.
Overcoming Setbacks and Achieving Milestones
Despite the hurdles faced, IJN continued to make significant progress in its digital transformation. In 2009, the hospital successfully implemented a Picture Archiving and Communication System (PACS), which allowed for more efficient storage and retrieval of radiology images. The next milestone came in 2010 when the hospital began utilizing Computerized Physician Order Entry (CPOE) systems for medication orders in outpatient clinics, a considerable step towards reducing medication errors. By 2014, IJN had taken another major step by generating electronic records for initial doctor consultations, operative notes, and discharge summaries through the Clinical Research Database.
These records initially focused on the Cardiac Surgery Department but later expanded to include the Pediatrics and Pediatric Surgery database, known as PaedsCare. This expansion was crucial in catering to an even wider range of medical needs within the hospital. Despite the initial setbacks, these achievements underscored IJN’s unwavering commitment to advancing its digital healthcare capabilities. Each milestone brought the hospital closer to a fully integrated EMR system, laying the foundation for future successes and ultimately contributing to its recognition under the HIMSS EMRAM.
The Role of Leadership and Change Management
Clinician-Led Change Management
A critical factor in IJN’s progress was the robust support from hospital management in helping staff acquire new skills and adapt to technological change. Dr. Alwi Mohamed Yunus, the clinical director of Health Informatics at IJN, emphasized that change management should be clinician-led, particularly by senior clinicians. This leadership approach played a pivotal role in achieving isolated successes in digitizing various processes within the hospital. The involvement of senior clinicians not only increased the credibility of the initiatives but also facilitated smoother transitions and greater acceptance among the medical staff.
This clinician-led model proved effective in fostering a culture of continuous improvement and adaptability. By engaging senior clinicians in the change management process, IJN was able to address concerns and preferences of the clinical staff more effectively. This collaborative approach ensured that the transition towards digitalization was seen as a collective goal rather than a top-down mandate. Consequently, this strategy was instrumental in surmounting initial resistance to technological adoption, paving the way for broader acceptance and successful implementation of digital solutions.
Strategic Learning and Focused Determination
The aspiration to digitally transform the entire organization persisted at IJN, leading to a search for a methodology that would enable holistic change across the hospital. At the beginning of 2023, an opportune moment arose when the Health Information and Management Systems Society (HIMSS) and the Malaysia Healthcare Travel Council (MHTC) signed a memorandum of understanding. This agreement aimed to develop Malaysia’s healthcare travel industry with a focus on hospital digital transformation. In a fortuitous turn, IJN was already seeking the MHTC Flagship Hospital status, which necessitated HIMSS EMRAM validation.
This synchrony provided IJN with a robust methodology to pursue an organization-wide digital transformation systematically. Leveraging the support from HIMSS and MHTC, the hospital could now systematically address its digital healthcare goals. This strategic alignment provided the necessary framework for IJN to systematically achieve the stringent requirements of EMRAM validation. With focused determination and structured guidance, the hospital continued its endeavor to integrate advanced technological solutions, ultimately marking a significant chapter in its digital transformation journey.
Achieving Stage 6 Validation
Forming a Dedicated Working Group
After assessing its EMR maturity in November 2023, IJN embarked on a focused effort to fulfill the requirements of the EMRAM. A critical step in this process was forming a hospital-wide working group dedicated to digital maturity validation. The working group was instrumental in ensuring a coordinated and comprehensive approach to meeting the EMRAM standards. In addition to forming the working group, IJN appointed an IT consultant to provide expert guidance throughout the process. This consultant played a vital role in navigating the complex requirements of EMRAM and ensuring that the hospital’s efforts were aligned with the necessary standards.
To comply with HIMSS standards, the hospital adopted a build-buy strategy, a pragmatic approach that involved building many functionalities using paper forms as templates and purchasing a clinical documentation engine compliant with international standards such as CMV, LOINC, and SNOMED. This dual strategy allowed IJN to customize solutions to fit its specific needs while ensuring adherence to established healthcare IT standards. The collaborative effort between the working group and the IT consultant was crucial in ensuring that IJN’s digital transformation efforts met the stringent criteria required for Stage 6 validation.
Implementing Advanced Systems and Technologies
The drive to achieve Stage 6 EMRAM validation was powered by an in-house team of IT experts, including skilled programmers and application specialists led by Fariz Zaki and Suriyani Azaman. The team undertook significant reengineering to set up critical systems, such as the CPOE of medication and allied health services. This reengineering was essential in streamlining and digitizing the medication ordering process, which enhances patient safety and operational efficiency. Moreover, the hospital implemented advanced, closed-loop systems for various medical procedures, including blood products, human milk, specimen collection, and medication administration.
A standout achievement in this effort was the implementation of the iBlood system, a closed-loop system for blood product administration. This system significantly enhanced patient safety by helping IJN achieve zero blood transfusion errors, with an impressive 96% of clinical users adopting the system. Such technology-enabled systems illustrate IJN’s commitment to leveraging advanced technologies to improve clinical outcomes and streamline hospital operations. The meticulous focus on standards and compliance for Stage 6 allowed IJN to prioritize core modules and assign specific tasks with defined timelines, ultimately meeting the stringent requirements of EMRAM validation and setting a new benchmark in digital healthcare.
Looking Ahead: Aspiring for Stage 7
The Path to Stage 7 Validation
Looking ahead, IJN is now aiming for the highest EMRAM stage, with hopes that their technology partners will assist in achieving Stage 7 validation. This next step represents not just a goal but a testament to IJN’s ongoing commitment to being at the forefront of digital healthcare transformation. Dr. Rhema Sundram, IJN’s Head of Customer Experience and EMRAM Clinical Sponsor, expressed optimism that achieving Stage 7 will showcase IJN as a technology-enabled cardiac hospital. The attainment of Stage 7 would demonstrate enhanced patient safety, better patient experiences, improved staff satisfaction, and greater work efficiency.
Achieving Stage 7 will require sustained effort and close collaboration between IJN and its technology partners. The hospital’s success so far lays a strong foundation for future advancements, but the journey to Stage 7 is expected to bring new challenges and opportunities. As IJN continues this quest, the hospital’s leadership anticipates that reaching this pinnacle will serve as a testament to the benefits of integrating cutting-edge technology in healthcare. It will also provide a critical benchmark for evaluating the hospital’s capabilities and readiness to deliver top-tier healthcare services.
Collaboration and Future Prospects
Institut Jantung Negara (National Heart Institute, IJN) in Malaysia has recently reached a major milestone by being validated for Stage 6 of the HIMSS Electronic Medical Record Adoption Model (EMRAM). This significant achievement marks the first instance of a hospital in Malaysia attaining this level of maturity in electronic medical record (EMR) capabilities, underscoring a dramatic advancement in the nation’s digital healthcare landscape. Reaching Stage 6 signifies that IJN has implemented and utilizes an advanced EMR system that enhances patient care, improves efficiency, and boosts overall healthcare delivery. This accomplishment is a testament to IJN’s dedication to elevating healthcare standards through cutting-edge technological progress. It also represents a momentous point in Malaysia’s journey towards a fully digital and integrated healthcare system. This landmark achievement not only showcases IJN’s commitment to pushing the boundaries of healthcare innovation but also sets a high standard for other medical institutions in the region to follow.
