OPPORTUNITIES, CHALLENGES & SOLUTIONS TO

THE DIGITALIZATION PROCESS OF

PAPER MEDICAL RECORDS

Dr. Vo Duc Chien – Nguyen Tri Phuong Hospital

– Ho Chi Minh City, Vietnam
Outline
Purpose & Objectives of the project
a. Background
 Advantages of Digital data
 The need to convert paper records to
digital data
b. Current stage: Challenges & Solutions
c. Preliminary plan
d. Conclusion
Purpose
To convert all medical paper records into
digital data in Nguyen Tri Phuong hospital

Objectives
1. Implement back scan to old medical
records. Records will be scanned reverse-
chronologically into the database
2. Scan new created records into the system
within 24hours
 Background
Data Digitalization: utilizing existing data & technology
advancements to completely transform the operation of the current
health information management system

New technologies such as data science, artificial intelligence ,

cloud computing and smart devices have entirely disrupted the
traditional way of medical practice model.
 Background (Cont.)
Alongside with the constant daily
practice, hardcopy/paper-based
information and medical records
have drastically piled up and are
rising in number throughout the
digitalization process.

This situation will be similar to

those of the other 1100 hospitals
consisting of over 180.000 beds in
Vietnam.
Retention period of Medical Records according to
Circular no. 53/2017/TT-BYT issued on December
29th 2017 from Ministry of Public Health

Part Document types Retention period

8 Document of clinical procedures describing 50 years
collaboration, quality control processes and
treatment plans in providing care to patients with
non- communicable diseases
20 Paper records of :
- Deceased patients 30 years
- Mental health patient 20 years
- Work-related injuries 15 years
- General inpatients & outpatients 10 years
The number of records keeps rising while the amount of destroyed records in
accordance with the regulation is very little.
The number of MRs destroyed after 10 years

60000 250

50000 200
40000
150
30000
100
20000

10000 50

0 0
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
2019 2020 2021 2022 2023 2024 2025 2026 2027 2029 2029

Total (458248) Deceased cases (1933)

Paper-based Medical Records Storage
in Nguyen Tri Phuong Hospital
 Current Retention method of
Paper Medical Records (MRs)
Total area required for The available space for
storage of paper MRs patient treatment
increases decreases

Out of space to
The number of patients’ files
expand the storage
becomes greater

High costs of storage and Low in cost

records management effectiveness
Reason to Implement MRs Digitization
Project
With NO full electronic medical records in place:
- 2 co-existing types: Paper-based vs Digital
Hospitals.
- Paper MRs are low integrity, it is challenging to
extract useful data, BUT create a huge financial burden.
With medical record digitalization in place:
- Unlimited Storage, permanent length of retention
- A Formation of Big Data, set a foundation for
future process of building medical knowledge databases
and the AI implementation into healthcare.
 Benefits of Digitalization
Improves professionalism standards

Guarantees & enhances patients’ safety

Protects patients’ privacy and confidentiality

Controls and manages medical treatment fees and

billing system precisely
Develops a knowledge database for the hospital (an
aid in planning treatment) via analysis of a vast
database, using AI software.
Provides wider range of provided services to patients
in timeliness and professional manner.
 Specific benefits to the Health Information
management (HIM) system (Cont.)
- Downsize storage space; solve many related problems:
storage space, flammability, damage and misplaced files…
Continue to be paper-based MRs
- Cost reduction in storage, management, tracking and
extraction
- Minimise human errors, improve data integrity
- Each MR will be digitalised : allowing the MR to be tracked
and extracted quickly and accurately; enhance data
accessibility, security and confidentiality.
- Cloud computing offers indefinite storage.
- A vast database for future AI usage will be available.
 Specific benefits to the HIM system (Cont.)
 Could be up to 25 % of the overall hospital’s cost due to
the reduction of storage cost, staff handling and
administration fee.
 Cost comparing between paper record keeping system vs
Scanned medical record in a project of record archiving
in Aus
 ~ 13 thousands individual paper records

 Until patient reaches 45 of age and it has been 20 years

since patient last contact with the hospital
Option Offsite storage Scanned record
Overall cost $4.500 x12 = $54.000 $75.600 AUD
AUD/ annually
Length of project 20 years & on-going 73 weeks
b. Current stage: Challenges & Solutions
Where we at?

 There are 4 types of HIM system

4. Data  These system are listed in a
warehouse hierarchy order, a system is built
_EMR upgraded upon the succeed and completion
of the one before it
3.Electronic
medical record
(EMR) system

2. Hybrid system

We are here
1. Paper-based system
Current stage:
_Challenges & Solutions_

1. The condition of paper records

2. Digital software
3. Internal business processes
4. Government policies & Standards
Challenge 1: The condition of Paper
records
 Paper is degenerated over time
 Poor paper condition  potentially jam a scanner
 Inconsistent Tracking system
 Missed files
 The way of how records created  might not compatible
with the scanner.
 Paper records are available in varied sizes, forms, paper
type
Strategies:
 Design and Implement a prepping and filling procedure
that suitable for this project
Challenge 2: Digital software and system
processes

Which data type

to backup
HL7- FHIR &
paper-based
medical records
CHALLENGES ON EXISTING TECHNOLOGIES
Scanning

Image processing

Optical Character Recognition

(OCR)

Data output & data conversion

Database indexing

Data storage
 SOLUTIONS
Establish a complete EMR data format based on HL7,
DICOM and the Ministry of Health’s regulations for
MRs.

Digitalize paper MRs and merge them to the EMR

database.

Use Artificial Intelligence to extract compatible data &

information when the Digitalization Process has taken
place
Example
A medical
records
appear on
digital
system
Challenge 3: Internal business process
Issues identified:
 Inconsistent protocols & procedures
 Staff’s Competency is varied
 Underestimated the importance of data entry
 The Helpfulness of IT support services
Solutions
 Regular audit and procedure reviewing to identify bugs
and pitfalls of the system
 Additional training is required
 Conduct survey to collect feedback and wishes from staff
to develop a practical strategic plan.
Challenge 4: Government Policies & Standards
- No policy legalises
the value of
digitalised paper MRs
Policies & -Digital signatures
Standards of clinicians is not
legally recognised

- Excessive paper
records Current
- Increasing in issue of
patients’ admission paper-
based
- The complexity of system
paper records
(structures, data
types, sources, ect.
c. Preliminary plan
Flowchart of a Digitalization Process
Project plan

Stage 1: Digitalize and establish an EMR

SYSTEM for data which doesn’t have a specific
format, is currently saved in computer files; this
will assist in extraction and research.
Stage 2: Digitalize and establish an EMR
SYSTEM for data which has a specific format and
is currently saved electronically. This will integrate
with the hospital’s EMR database system,
optimising the use and benefits of EMR.

EMR: Electronic Medical Record system

Stage 1

Scan paper records, file them into appropriate folders according

to the Regulation 54/2017/TT- BYT & 46/2018/TT- BYT.
Implement the digitalisation project in the hospital
Develop indexing table and search engine for data tracking and
retrieving
Input data into the Cloud Computing
Develop high-compatible software enabling data tracking,
retrieving, and security guaranteed
Stage 2

Identify, encode and extract data

(only apply for those digitalsed data from the 1st stage)
Create an electronic database
Combine encoded data and EMR data into a mixed
hospital database (Big Data)
Modify and upgrade the current in-place health
information system to accumulate and allow data transfer
into the Big Data
Preparation stage
Design a strategic plan and action plan for this project,
specifying into each stage.
Seek and develop partnerships & sponsorships
First and foremost, introduce & implement Stage 1
 Implement a trial plan in a specific area/ wards in a defined
time frame
 Expand the scope to the whole organisation
Evaluate the result of the previous stage
Plan ahead and start Stage 2
 Implement a trial plan, then expand to the whole
organisation
 CONCLUSION

DIGITALIZATION OF PAPER-BASED
MEDICAL RECORDS is:
An Urgent need,
With facing challenges

But achievable project

And significant benefits

Thank you for
listening