From paper to digital – The Medical City shares on EMR roll-out journey

Mr Nelson Tiongson, Chief Information Officer of The Medical City in the Philippines, shares learnings from their EMR roll-out, and integration of information from both paper and digital sources

Adoption of EMR (electronic medical record) systems in hospitals continue to ramp up across the world, with latest research projecting a CAGR of 7.8% in the global hospital EMR systems market between 2020 and 2025.

Reasons cited behind this trend include government mandates and support, and also growing patient volumes which have triggered the need for hospitals to boost efficiency and streamline processes.

This means that over the next few years, an increasing number of hospitals will be embarking on the transition from largely paper-based workflows to digital ones – not an easy feat by any means. During the transition, integration of paper records into EMRs can be tricky, in ensuring paper and digital data are comprehensively and safely captured into one complete patient profile.

Securing data on both fronts

An important consideration for hospitals straddling both paper and digital records is securing data on both formats and during the transfer process.

Mr Nelson Tiongson
Mr Nelson Tiongson

Mr Nelson Tiongson, Chief Information Officer of The Medical City – the largest healthcare network in the Philippines – noted that per the country’s data privacy laws, there are three aspects of data protection: physical, process and technology.

For example, he noted that upon patient discharge, the physical patient record would be taken from the nursing unit to the medical records department, which is a secured physical location.

“Only medical records staff have access to the records, and no unauthorised personnel are allowed to enter the unit,” he emphasised. “We have different access restriction measures – for example, doctors who wanted access to the records would have to put in a request to the medical records administrator, and access will only be granted for a limited time. So the process of granting access is controlled and structured.”

From the technological perspective, strong data protection and security capabilities need to be built in within the hardware and software used. Besides the adopted EMR system, Mr Tiongson noted that the document management system used at TMC is certified compliant with HIPAA and GDPR guidelines in data protection, which ensures scanned medical records are securely stored.

However, it is key to recognise data security as an ever-evolving technology.

“What we also need to do is to beef up or upgrade our security protocols, because as hospitals we are dealing with sensitive and personal information,” said Mr Tiongson. “So we have risk assessment tools that we are constantly reviewing. If our assessment finds any of our protocols at high risk from any breaches, we need to update our security measures.”

One area identified as high risk in recent years was data access from mobile devices.

“We are focusing on how we can monitor devices that have been given access to our systems. Technologies such as multifactor authentication and firewalls serve as security gates, to make sure that the right person is accessing the right data for the right purpose,” he said.

TMC lobby

Transitioning from paper to digital

The main TMC facility in Pasig City, Metro Manila, has just completed its transition to a new, comprehensive EMR in July 2021, moving away from a hybrid EMR-paper system which has been in place since 2017. Key new features include Computerised Physician Order Entry (CPOE), which allow physicians to enter and send orders – medication, laboratory and so on – digitally, thus cutting the majority of paper workflows.

Implementation of such new major systems, at a facility the size of TMC Main, was definitely not easy, said Mr Tiongson. For example, during the previous phased implementation, there were certain workflows which required clinicians to complete paper records and also input the same data into EMR – a step seen as redundant and adding to clinicians’ workload, and affected willingness to adopt.

However, when the new EMR was rolled out using the full implementation approach, such double work will not be required. Thereby, the switch to digital has cut a fair amount of staff workload needed to manage paper trails, said Mr Tiongson.

Previously, the process was to have all paper records available electronically, and stored in a digital document management repository. “We had a team of people that were scanning and indexing these files. For example, for medical records, it is the medical records department that does it,” he said. “Sometimes, when paper documentation was not complete, staff had to go and look for the doctor to have them sign or complete something that they had left out. It was really tedious.”

“With the shift to EMR, the amount of scanning work has significantly dropped, and the workload is now more reasonable.”

Role of existing paper workflows

Now that the core functions of the EMR have been successfully implemented, the next step for TMC is to “digitise processes specific to each clinical specialty, since each speciality has a different process and data requirement,” said Mr Tiongson.

Some specialities currently refer to hardcopies of data presented into a table, comprising all lab results done to date, for an overview of patient’s medical history. The way it is currently accomplished is that nurses or other clerical staff compiles them manually into paper or word documents to be printed.

“That is a little bit difficult for us to duplicate electronically, because the data sources come from different systems, and some are still manual,” he explained. “It entails automating some processes first, before being able to capture that data together and have them aligned on one form.”

Some other paper workflows that remain are informed consent forms, as the relevant regulations regarding consent are being worked through.

Also, admitting order sheets (for admission of inpatients) sent in by TMC doctors who are also working at other hospitals or clinics, are still mostly paper as well, as remote access of the EMR is not granted outside the hospital. Patients present these paper documents upon admission, and TMC staff will have to transcribe these into the system.

“Some forms are not really difficult to digitise and have them available in the EMR, but setting the right processes in accomplishing these tasks is the more challenging part. After all, utilisation and safety are the main objectives,” said Mr Tiongson. “Do we open access to doctors anywhere? That is a big potential risk in terms of data security… Do we have the capabilities for such access, and can we put in the necessary protocols? These are just initial thoughts that need to be laid out as part of the whole end-to-end process, but a very significant decision point that we have to assess moving forward.”

For now, paper-based workflows continue to play a role in healthcare systems. For hospitals which are looking for efficient ways to manage paper trails or integrate paper records into EMRs, one solution to look at could be smart multi-function printers (MFPs). Lexmark’s MFPs offer direct scanning at point of care, with scanned documents automatically sorted and indexed, and captured into the hospital’s EMR or information management systems.

Click here to learn more about Lexmark’s Point of Care Scanning solution. You can also contact Lexmark’s Healthcare Consultant at to learn more about Lexmark’s clinical solutions and assessment of your facility’s printing requirements.