Abstract:

The Intellectual skill of a Physician depends on his ability to make precise and appropriate
decisions as he prescribes medications to his patients. This skill can be more effectively
implemented when it is accompanied with a proper Medications history of the patient.
When it comes to clinical settings, even the standardized therapy for treating Tuberculosis fails
to achieve its goal if the patients past medical history is unknown or vague, thereby making him
consume the same medications he used in the past to which he was resistant.
Failure to achieve seizure threshold often results from improper selection of Anti-epileptics
because of improper medication history presented by the patients.
In a country like India where poverty is a predominating factor, it is difficult to expect detailed
medication history from patients. Lack of awareness towards Medical history preservation, Plain
paper prescriptions which are more liable to be misplaced or damaged, difficulty in maintaining
detailed patient history of chronic illnesses, Decentralized nature of health care systems etc.
demands for sophisticated techniques of Medical Record maintenance.
One such attempt of providing intact and precise Medical History of Patients is our I CARD. It
aims to deliver all the minute medical history (which counts for Health care) of a patient, thereby
making him the ideal candidate to receive the finest possible Medication therapy.

Abbreviations:
EMR : Electronic Medical Recording.
EHRs: Electronic Health Record schemes.

Market Trends:

Medical Record keeping assists doctors by retaining and communicating patient medical history
in a portable, convenient format such that it allows rapid & effective decisions regarding the
design of an ideal pharmacotherapy by reducing unnecessary and repetitive procedures. The
natural medium with which medical records were maintained all these years is paper as it is
simple to use, low in cost, and durable. Information may be quickly added and readily shared
amongst health professionals during health care. However, problems arise due to the
decentralized nature of the healthcare system; patients frequently visiting different centers of
health care etc. are impeding the necessary flow of medical information. Fragmented, incomplete
patient records pose an obstacle to patient care making them more prone to inappropriate
medication therapy and increased health care cost.
A system of electronic medical records provides an infrastructure where all medical records are
digitized, then stored and transferred electronically. Popular companies are fond of publishing
reports in favor of using electronic medical records out of which Hewlett-Packard, Google,
Microsoft etc. have already made an impact.
Development of electronically linked patient records or Electronic Health Record schemes
(EHRs) is a priority for governments in many countries, including Australia, as part of a vision
for future health care services using call centers, web-based patient information and tele-health.
EHRs offer health care providers access to a more complete medical history of a patient, with the
patients consent. EHRs therefore promise to improve the quality of health care services,
promote a more integrated approach to care and offer consumers an opportunity to better manage
their own health care.

With EMR showing greater promise in enhancing patient care and optimizing the
pharmacotherapy of the patients, it is being widely accepted and warmly welcomed into the field
of health sciences. With major countries showing great interest towards EMR, there is a greater
scope in implementing wide aspects into these systems and enriches the overall technology used
in it.
The ideal and easy way of carrying an Electronic health record would be a Smart Card.

A smart card is defined as a "card incorporating one or more integrated [electronic] circuits
within its thickness. The smart cards which are employed in EMR are those with
microcontrollers that encrypt all information on the card, are tamper proof, and securely
communicate with a reader. In regards to reader interfaces, there are two major types of cards:
contact cards, where there is physical contact with a reader; and contactless cards, which are read
wirelessly with radio frequency identification (RFID).

Solutions:

In order to combat the ever existing problem of Medication record miss-management, especially
in rural Indian population, we propose the development of a personal medical smart card system,
I CARD for maintaining and transferring patient medical records. Each patient, if he or she
elects to do so, will carry a credit-card fashioned personal smart card containing his or her
medical records which includes all details regarding their past medical history also current medical
problems and current treatment, including lab tests and other diagnostic tests performed.

The data on these cards cannot be accessed unless the card is inserted into a special card reader
regulated by the management personnel and distributed to registered healthcare providers. When
read, the provider will be able to access the patients medical records and convert the information
into the preferred format with which the provider stores patient files. Providers will be
responsible for updating the card with any relevant changes.

Our proposal of using smart cards as the medium of patient record transfer between healthcare
organizations does not depend on the type of database organizations use internally to store
information, and it requires no centralized medical record database. In addition, implementing
such a system will effectively begin converting all current paper based medical records into
electronic format, serving as a key intermediate step towards transitioning into fully nationalized
electronic medical records.

If a healthcare provider already has an electronic records system, it is possible to synchronize

data on the card with the hospital records every time the card is scanned; any new tests or

reports can be uploaded both ways. This ensures that the physicians get to know the recent
laboratory data rather than an approximate data provided by him or old data from available
records.

Having a complete medical information record in the form of card held safely in a wallet
provides critical information in case of a medical emergency. When a patient is in unconscious
state or in any other unfavorable health condition is brought to a health care center, I CARD
acts as a single pivotal tool which guides the physicians in making the correct clinical
decisions and provide the best therapy. With a card that can quickly be scanned, any
emergency room doctor has all relevant information and can make effective choices for patient
care.

Each card will contain a photo (also printed on the card), birth date, blood type, allergies,
prescriptions, and any other medical information. The data structure can be a modular container
to allow addition of new or atypical data fields if it becomes necessary, much as the structure of
ID3 tagging allows for appending any data to audio files. Finally, a security log will be kept to
record all card activity

Best Practices:
The present scenario in India is that, few of multi-specialty hospitals in the country have started
to record their patients medication history in Electronic Medical record systems so as to access
their past medical records. Few hospitals were very successful in implementing the idea and also
extract the fruits out of it. The implementation of EMR lead to enhance understanding of patient
clinical condition and also to minimize many drug related problems.
The Local ruling Governments in few states of India also asked their respective Health ministries
to look into the implementation procedure of EMR in all their respective Government Aided
hospitals. This can be considered as a brave and applaud able step taken by the respective State
Governments keeping in view, the safety of their public. Once the ruling Government take steps

for the implementation of such modern techniques, it gives a boost to other corporate and local
bodies to aim and implement the same.
The only problem associated with the above mentioned steps is that, It limits the Medical data to
that Multi specialty hospital or the Local Government hospitals and cant be processed beyond it.
This confine the medical data to a specific Hospital or a place and any medical record
developments beyond that particular place cannot be accessed. This restricts the Data from being
freely accessed in different parts of the country.

Common Issues:
In spite of the numerous advantages, there exist some factors which act as major obstacles in the
implementation of this project.
Patient Privacy is one the major concern in this format. As the medical records are being put at
an accessible point for provider and the physician, lack of privacy is one factor which hinders
patients from getting into the EMR system. Various steps were taken into consideration to
protect the patients privacy.
The Health Information Portability and Accountability Act (HIPAA) establishes national
standards for electronic health care transactions and addresses security and privacy of health data
Patient medical records are considered protected health information under federal and any
changes or accessions of medical records must comply with HIPAA to maintain patient privacy.
Medical information needs to remain accessible to qualified professionals yet inaccessible to
unauthorized persons to prevent identity theft or compromise of confidential patient medical
history.

Accountability of the data that is being entered into the records is another problem faced during
the implementation of this project as there is a chance of manipulating the records and lab data
that is being entered into the records. Therefore stringent actions should be taken to control this
problem. Medical records including physician orders as well as exam and test reports are
considered legal documents and must be kept in unadulterated form. Doctors or other

professionals may make errors, so it is important to maintain truthful, accurate information

regarding patients.

Impact on Efficiency: Medical records systems play a fundamental role in healthcare because
they communicate patient information between professionals. A bottleneck in this critical
process will slow down overall patient care; medical information flow is especially prone to
delays because it involves personnel who must physically examine and transcribe data. Therefore
flawless software programs and reliable personnel are required to prevent this kind of problem
and make sure that Medical data is readily available at any instant of time.
Cost Factor is another problem which the projects faces during its implementation. In order to
implement such a huge project all over the country in wide variety of health care centers, it
requires huge budget to install this project in each and every corner of the Nation. This is exactly
where sponsors play a key role in the implementation of the project. With mutual negotiations
between the Management and Sponsors boosts up the implementation of project in many distinct
places of the country.

Conclusion:

The current scenario of Health care system has many ambiguities when it comes to provision of
optimal health care, out of which poor Medical history is one of the predominating factor.
Health care centers being de-centralized, Lack of intact medical records, Government health
schemes being misused, policy makers eyeing on modernized medical record keeping to mitigate
cost of health care, all these issues call for a standardized means of Managing Medical record
making and I CARD provides the perfect platform to meet all the desired criteria and bring in
drastic change in the field of medical record management.