Amira is a middle-aged Pakistani woman, working as a housekeeper for a wealthy family in Faisalabad. Her daughter has recently been diagnosed with early-stage kidney disease. After weeks of trying, she finally manages to get a day off to take her daughter to a nephrologist at a public hospital. The specialist requests all of the patient's medical records. Amira presents a thick folder of documents. However, it's discovered that a crucial blood test result is missing. The doctor informs Amira that she needs to have her daughter's blood work redone before they can proceed with treatment. Now Amira must find the funds to pay for additional tests and also convince her employers to grant her another day of leave. In the meantime, her daughter's condition continues to deteriorate.
When a healthcare system has no proper infrastructure for medical record keeping, the result is waste and medical errors. For example, the cost of repeat lab work will either be borne by Amira if she goes to a private lab or by the taxpayer if she opts for a government one. Repetition of tests will also use up limited laboratory resources and delay the test results of other patients. Amira's story also points out another avenue of concern: medical misdiagnoses. Generally, a primary care physician, or family doctor, ensures an individual's health through keeping family histories, doing annual health screenings and ensuring immunisations. These doctors maintain all this information in the form of electronic medical records. Amira's daughter had no such family doctor to track her dietary habits or note the prevalence of kidney disease in her family history. In fact, the first doctor she saw gave her antibiotics for what he diagnosed as a urinary tract infection.
In a country with less than 125,000 government hospital beds for more than 220 million people, there is little room for such errors. According to the World Health Organisation (WHO), Pakistan has one of the lowest per capita current health expenditures among South Asian countries, trailing behind several of its neighbors. Due to persistent economic challenges and debt issues, Pakistan's healthcare spending is likely to remain limited. In such a resource-constrained environment, technology presents a relatively affordable tool that can be utilized to improve efficiencies and enhance overall population health outcomes.
Pakistan's major urban centers house a limited number of secondary and tertiary care hospitals, designed to offer inpatient care, ambulatory services, and specialized treatment. However, the vast majority of the country lacks access to such facilities. In rural areas, the primary public health establishments are small centers known as Basic Health Units (BHUs). With over 5,500 BHUs scattered across Pakistan, these provide outpatient services to the general population. In contrast, the private healthcare sector is dominated by specialist care, with doctors operating their own independent clinics. In this context, primary care is viewed as neither financially rewarding nor prestigious. Consequently, patients often resort to self-diagnosis before deciding which specialist to consult.
To bridge this gap, some private institutions have emerged to provide comprehensive healthcare services to underprivileged populations. A notable example is Madinah Teaching Hospital (MTH) in Faisalabad. MTH is a 600-bed general hospital that aims to alleviate suffering among underserved patients by offering high-quality health services without discrimination. Attached to University Medical and Dental College and The University of Faisalabad, MTH is recognized by key medical authorities for both graduate and postgraduate programs.
MTH's mission involves providing state-of-the-art medical and nursing services to deserving community members, while also fostering a culture of research for improved patient care and treatment. With a dedicated team of qualified professionals working around the clock, MTH offers an alternative to limited public facilities and expensive private specialist clinics. This model of care helps address issues such as the lack of primary care in private settings and limited access to specialized care in rural areas, potentially offering more coordinated care and reducing the risk of misdiagnosis and repeated tests that burden patients financially and emotionally.
The team at Madinah Foundation has developed an innovative software solution to transform physical registers into electronic medical records (EMRs) at Madinah Teaching Hospital (MTH). This digital transformation represents a significant step forward in modernizing healthcare record-keeping and improving patient care efficiency.
Dr. Ahmed explains the motivation behind implementing Electronic Medical Records (EMR) at their institution: "We implemented EMR primarily to evaluate our departmental performance effectively. Prior to this system, we lacked reliable methods to measure key metrics such as doctor-patient ratios or daily birth rates." His statement highlights how EMR not only improves patient care but also provides valuable data for hospital management and resource allocation.
At each Basic Health Unit (BHU), staff members access the system using their unique Computerized National Identity Card (CNIC) number, with different modules available based on their role. Patient registration begins with their CNIC number. The receptionist records and inputs the patient's vital signs into their profile. During the consultation, the doctor selects a diagnosis and prescribes medication within the system. Lastly, when dispensing medicine, the pharmacist marks the prescription as filled, which automatically updates the inventory records.
Dr. Ali expresses reservations about transitioning to a fully digital system, citing practical challenges. "Registering all 200 patients electronically is nearly impossible due to our resource constraints," she explains. "The slow internet speed in this area is also a significant hurdle."
However, Madinah Teaching Hospital (MTH) is taking proactive steps to address these concerns. The institution is providing high-speed internet access to all doctors, facilitating a smoother transition to online record-keeping. This initiative by MTH aims to overcome the technological barriers that often impede the adoption of electronic medical records in resource-limited settings, enabling a more efficient and comprehensive digital healthcare system.
Privacy remains a significant concern in the implementation of electronic medical records. Recognizing this, MTH has invested in state-of-the-art data centers to ensure the security and confidentiality of patient information. The institution aims to extend this ERP system to hospitals across Pakistan, potentially revolutionizing healthcare record-keeping nationwide.
The success of these initiatives will ultimately be determined by their long-term implementation, adoption, and the development of supporting infrastructure and policies. As Pakistan navigates this digital transformation in healthcare, time will reveal the full impact of these technological advancements on patient care and health outcomes.
Health Sciences Wing