Empowering the patient: Smart Card (SC) Integration with Electronic Medical Record (EMR).

Tata Memorial Hospital (TMH) is a Comprehensive Care Centre for Cancer located in Mumbai, India. Patients from all over India and some from neighboring countries choose to travel to Mumbai (Bombay) to receive treatment at our centre. Given the geographical constraints, TMH has adopted Information Technology to reach out to patients in distant communities. TMH has a home-grown Electronic Medical Record System, the contents of which are shared with patients and providers over the hospital- wide Intranet, and globally through our website. TMH has been carrying out paperless and filmless operations since 2013, enabling the real time exchange of information and ensuring a continuum of care. Paper Records preceding this year are scanned, archived and made available as part of the EMR. Prior to Smart Card implementation, it was not uncommon to find patient or their relatives queuing up for services or payments. This had resulted in delays in providing services, and hardship for patients and their relatives. Overcrowding meant staff being stressed with a propensity for mistakes in data entry, resulting in a faulty service. This would compromise patients if unnoticed, or result in a repetition of service it noticed. In addition, hospital management was concerned about lengthy transaction times and deficiency of service. It was in this context that in the year 2011, the Hospital Management took an initiative to integrate Smart Card Technology with the existing Electronic Medical Record (EMR) and Electronic Financial Record (EFR), to improve interaction between patients and the Institution. The strategy was to use Smart Card (SC), containing an embedded IC chip for patient identification, to carry out all transactions involving patient care, in order to minimize transcription errors and enhance patient safety. The implementation of this strategy involved process re-engineering and training of all staff members. The results of the past 4 years 2013-16 have been analyzed to determine the efficacy of this initiative.

Hypoplastic left heart syndrome with restrictive atrial septum and advanced heart block documented with a novel fetal electrocardiographic monitor.

Hypoplastic left ventricle with congenital heart block has been reported previously in a fetus with concurrent left atrial isomerism and levo-transposition of the great arteries. We present the unusual case of an infant diagnosed in utero with hypoplastic left heart syndrome, a restrictive atrial septum and advanced heart block but with D-looping of the ventricles and no atrial isomerism. In addition, fetal heart rhythm was documented with the assistance of a new fetal electrocardiographic monitor.