In Nepal, it has been too late to implement an integrated system so that health institutions can receive information about patient tests electronically. It is necessary for the Ministry of Health and Population to start an electronic medical record system in order to make health service delivery technology-based, realistic, efficiency-based, accessible and customer-friendly. Although such a system has been used by western and developed countries for a long time, its practice has not yet started in Nepal.

An electronic medical record (EMR) is a system that stores every person's medical records digitally. Under this, any health institution has to record the records of the patients who have received services from them in the prescribed system with 'unique code number' or 'unique health number'. If it can be searched or viewed electronically from anywhere in the country, the authorized health workers can also take appropriate treatment decisions by looking at the past history of the patient. 

Recently, under the leadership of Health Minister Pradeep Paudel, the Ministry has issued the 'Integrated Electronic Medical Record System (EMR) Operation and Management Guidelines, 2081'. Health experts have been insisting on the implementation of electronic medical records system in Nepal for a long time. In particular, the need and importance of EMR was discussed in Digital Nepal Framework, National e-Health Strategy 2074, National Health Policy 2076, e-Health Guidelines 2076 etc.

As the country moved to a federal system, all three levels of government started working on electronic health information management. All those efforts are expected to be managed and integrated by this guide at the national level. In the directory, the service user's health details are based on any government official document such as health insurance, national identity card, citizenship, voter's ID card, driver's license or any government-recognized identity card that discloses personal details including senior citizens. There is a provision to manage health data. A unique identification number (Unique Identity Number) should be provided from the combination of these numbers.  The

directive has also provided for the establishment of a separate resource center in the ministry for the operation and management of the electronic medical record system, the formation of a technical work committee and a regional coordination committee. The directory has also opened the way to partner with universities and academic institutions. Since the treatment information of any patient will be kept in one unique ID, it can be expected that this system will bring fundamental changes in Nepal's healthcare system. 

In addition, through the practice of such a machine-readable (QR code) system, coordination and efficiency between health institutions, accurate information will be obtained immediately in "real time", improvement in the health treatment of patients, related health institutions and doctors Information can be shared securely and patients themselves can access their medical records and make appropriate decisions. It will also help the government to analyze the collected data and decide the public health strategy. Also, it can be believed that it will bring transparency and accountability in the process of claiming, monitoring and approving health insurance. If a health institution is providing telemedicine services, electronic records must be maintained compulsorily. Similarly, within one year of implementation of the directive, all hospitals must install this system compulsorily.

international experience 

International experience has shown that the implementation of this system will help in the evidence-based decision making process and better coordination of patient care. 

The research conducted in various hospitals in the United States has shown that after the implementation of EMR, the health services provided by the hospitals there are fast and reliable, and the cost has also decreased. A study conducted in Saudi Arabia found that after EMR implementation, patients reported better treatment and physician consultation experiences than before. Similarly, another study conducted in Nigeria stated that after the implementation of EMR, the patient's waiting time in the health centers there decreased and they were satisfied with the doctor's consultation. 

India has reported that more than 670 million Ayushman Bharat Health Accounts have been opened in the past three and a half years since the implementation of the Ayushman Bharat Digital Mission in September 2021. According to the Ministry of Health and Family Welfare of India, the health records of more than 420 million patients have been added to Ayushman Bharat Health Accounts, while 13 lakh health institutions including 17 thousand private hospitals are included in the plan. have joined. 

Opportunities and Challenges

In 2006, the World Health Organization (WHO) published "Electronic Health Records: Manual for Developing Countries" when trying to implement EMR, computers and related It has been mentioned that questions may arise such as lack of resources to purchase the system, lack of sufficient trained manpower, security of collected data and whether the patient can get the data when requested. In order to solve such problems, it is necessary to pay attention from the beginning. Similarly, WHO has suggested technical infrastructure, site preparation and system testing. Similarly, WHO has proposed a smart (standardization-based, machine-readable, system-friendly, needs-based, and testable) guideline framework for implementing EMR systems, which is also appropriate in the context of Nepal. Can. 

As Nepal is trying to improve health insurance, the EMR system can also serve as its foundation. It is sure to make the treatment process of the patient faster, easier and more efficient while moving the healthcare system towards digitalization. In addition, disease diagnosis, data management and long-term health strategy creation will also contribute greatly.