Institut Jantung Negara (IJN), the National Heart Institute in Malaysia, has recently achieved a significant milestone by being validated for Stage 6 of the HIMSS Electronic Medical Record Adoption Model (EMRAM). This achievement marks a first for the country and highlights IJN’s ongoing efforts toward digital transformation in healthcare. Founded in 1992, IJN is a public quaternary care hospital with 433 beds, handling over 300,000 outpatients annually, demonstrating its vast scope and influence within Malaysia. Despite facing numerous challenges, IJN’s journey toward digital maturity has been marked by persistence and strategic planning, continually striving to integrate advanced technologies into its operations.
The Beginning of IJN’s Digital Journey
IJN’s digitalization efforts began in 1998 with the acquisition of the MedTrak hospital information system. Over the next two decades, the hospital encountered several obstacles in implementing a successful organization-wide EMR system. One of the significant challenges was change management, particularly with physician acceptance of MedTrak and its upgrade, TrakCare, in 2009. Dr. Alwi Mohamed Yunus, the Clinical Director of Health Informatics at IJN, pointed out inadequacies in clinical documentation as a critical issue, further complicating the adoption process of these new systems.
In addition to change management, IJN faced difficulties in integrating an EMR system with an external vendor between 2021 and 2023. The lack of cohesion between the primary vendor and the hospital’s implementation partner led to the failure of this attempt. This setback did not deter IJN’s ambition; instead, they continued to strive for digital maturity, achieving several milestones along the way. This unyielding spirit has been central to their progressive journey toward comprehensive digital integration within the hospital setting, despite the many hurdles they have faced.
Milestones in Digital Transformation
In 2009, IJN marked a significant milestone by implementing a Picture Archiving and Communication System (PACS), setting the stage for further technological advancements. This was followed by the introduction of Computerized Physician Order Entry (CPOE) of medications in outpatient clinics in 2010, representing a key step toward enhancing the efficiency and accuracy of medical prescriptions. By 2014, the hospital had started generating electronic records, such as initial doctor’s consultations, operative notes, and discharge summaries, through its Clinical Research Database. These digital records were initially within the Cardiac Surgery Department and later expanded to the Pediatrics and Pediatric Surgery database, PaedsCare.
Throughout this journey, hospital management provided full support to staff in learning new skills, emphasizing the necessity of senior clinician-led change management. This comprehensive support system helped IJN to achieve isolated successes over the years, gradually building a foundation for their larger goal of comprehensive digital transformation. The search for a methodology to enable holistic organizational change ultimately led them to the HIMSS EMRAM, providing a structured framework to advance their digital maturity efforts systematically and strategically.
Aligning with HIMSS EMRAM and MHTC
In early 2023, HIMSS signed a memorandum of understanding with the Malaysia Healthcare Travel Council (MHTC) to develop the country’s healthcare travel industry by promoting hospital digital transformation. Conveniently, IJN was already striving to secure the MHTC Flagship Hospital status, a designation that requires a HIMSS EMRAM validation. The structured methodology provided by HIMSS EMRAM became instrumental in IJN’s digital transformation efforts, offering a clear roadmap to follow in its quest for higher EMR adoption stages.
After conducting a baseline assessment of its EMR maturity in November 2023, IJN focused on fulfilling the EMRAM requirements to advance to Stage 6. The hospital formed a hospital-wide working group dedicated to digital maturity validation and appointed an IT consultant to ensure compliance with HIMSS standards. Employing a build-buy strategy for its system, IJN built most functions using existing paper forms as templates and acquired a clinical documentation engine to ensure compliance with CMV, LOINC, and SNOMED standards. This strategic approach allowed IJN to align closely with international standards while efficiently addressing the specific needs of its healthcare setting.
Overcoming Challenges and Achieving Stage 6 Validation
Significant reengineering work was undertaken to set up the CPOE of medication and allied health services, ensuring a seamless integration of technology with daily medical practices. This included implementing closed-loop, technology-enabled systems for blood products, human milk, specimen collection, and medication administration, enhancing the safety and reliability of these critical processes. Dr. Rhema Sundram, IJN’s Head of Customer Experience, noted that by focusing on standards and compliance elements necessary for Stage 6, IJN could prioritize core modules and assign tasks with specific timelines efficiently. This focus on structured implementation and detailed planning played a crucial role in their successful Stage 6 validation.
During validation, IJN demonstrated the efficacy of its closed-loop system for blood product administration, known as iBlood. This system has achieved zero blood transfusion errors, a significant accomplishment, and is currently adopted by 96% of clinical users. IJN now aspires to attain the highest EMRAM stage, with hopes that technology partners will collaborate to achieve Stage 7 validation. A successful Stage 7 validation would enable IJN to showcase its technology-enabled cardiac hospital, offering improved patient safety and experiences, as well as enhanced staff satisfaction and work efficiency. This ambition underscores the institute’s unwavering commitment to leveraging technology for superior healthcare outcomes.
The Road Ahead for IJN
Institut Jantung Negara (IJN), the National Heart Institute in Malaysia, has recently reached a notable milestone, being validated for Stage 6 of the HIMSS Electronic Medical Record Adoption Model (EMRAM). This achievement is a first for the nation and underscores IJN’s commitment to advancing digital transformation in healthcare. Established in 1992, IJN is a public quaternary care hospital with 433 beds and attends to over 300,000 outpatients each year, reflecting its significant role and influence within Malaysia’s healthcare system. Despite facing numerous challenges along the way, IJN’s journey towards digital maturity has been characterized by determination and strategic foresight, consistently aiming to integrate cutting-edge technologies into its operations. This progress not only enhances patient care but also sets a benchmark for other healthcare institutions in Malaysia, demonstrating what can be achieved through dedication to innovation and excellence in medical services.
