Paper vs. Electronic Medical Record Keeping

Medical records are the document that explains all detail about the patient’s history, clinical findings, diagnostic test results, pre and postoperative care, patient’s progress and medication. If written correctly, notes will support the doctor about the correctness of treatment.

It is very important for the treating doctor to properly document the management of a patient under his care. Medical record keeping has evolved into a science of itself. Medical records form an important part of the management of a patient. It is important for doctors and medical establishments to properly maintain the records of patients for two important reasons. The first one is that it will help them in the scientific evaluation of their patient profile, help in analyzing the treatment results, and plan treatment protocols. It also helps in planning governmental strategies for future medical care. But of equal importance in the present setting is the issue of alleged medical negligence. The legal system relies mainly on documentary evidence in a situation where medical negligence is alleged by the patient or the relatives.

Despite knowing the importance of proper record keeping in India, it is still in the initial stages. The lack of basic health data renders difficulties in formulating and applying rational patient care and disease prevention.

A good medical record serves the interest of the medical practitioner as well as his patients. It is very important for the treating doctor to properly document the management of the patient under his care. Medical record keeping has evolved into a science.

Objectives of Maintaining Medical Records:

  • Monitoring of the actual patient
  • Medical research
  • Medical/dental or paramedical education
  • For insurance cases, personal injury suits, workmen’s compensation cases, criminal cases, and will cases
  • For malpractice suits
  • For medical audit and statistical studies

With paper medical records, all you need to get started is paper, files, and a locked cabinet to store all the documents. There’s a reason why paper medical records were an industry mainstay for several decades. It’s easy to pull up information from a file, examine previous notes and medical charts, and record new observations. If the information is written clearly, there can be fewer complications in reading charts and notes on paper.

Paper records are advantageous in this sense: a physical file with all previous charts and medical history neatly sorted in one place. Plus, the data can be physically passed around from one person to another seamlessly. Of course, all of this depends on the previous notes being neatly written, properly organized, and readily accessible.

Paper medical records need physical space for storage purposes. What do you do if there’s a fire that wipes out all your physical files? Or a moth infestation that, quite literally, eats up all your data? Physical files, once lost, are impossible to recover.

Paper medical records mean you need a manual written process which is both time-consuming and comes with a higher degree of error. If you’ve ever attempted to read a doctor’s notes, you’ll know that the writing isn’t always legible and therefore can be hard to interpret.

While paper-based records can be easier to customize, it also means that the layout and format of information can be inconsistent from one record to the next. When paper-based records have different layouts, it extends the time needed to get the information needed for a patient.

Paper records don’t have built-in version histories and audit trails. Knowing who made which edits and additions require that the physician signs the records each time. If changes are made, it’s not easy to locate where the changes were and who made them.

When it comes to deciding between papers vs. electronic records, there are a few things you must take into consideration.

Electronic health records are far more secure than paper records as they’re not at risk during a catastrophic event. It’s also easier to retain accountability in electronic health records — each entry log is consistent with a specific individual.

An electronic system doesn’t have these problems — records aren’t handwritten, so the legibility issue isn’t an issue at all. Plus you don’t have to search for patient files in a physical cabinet — the software does that for you (instantly).

Electronic health records have a consistent format that healthcare providers can get accustomed to. Electronic health records ship in a customized format that helps with things like legibility & accuracy of medical data. Paper-based records can involve human error and a loss of data integrity.

Dr Judhajit Roy Choudhury teaches sisters about surgical wound site care and complications at the Paras HEC Hospital in Ranchi for better patient care and healthcare delivery.

World Family Doctor Day | 19 May

World Family Doctor Day (FDD) – 19th May: was first declared by WONCA in 2010 and it has become a day to highlight the role and contribution of family doctors and primary care teams in healthcare systems around the world.

WONCA is an unusual, yet convenient acronym comprising the first five initials of the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians. WONCA’s short name is the World Organization of Family Doctors

This celebration is the perfect opportunity to acknowledge the central role of Family Doctors in the delivery of personal, comprehensive and continuing health care for all the patients. It’s also a chance to celebrate the progress being made in family medicine and the special contributions of primary care teams globally.

Family Doctors are present at all times, and continuity is a fundamental feature of their work. They continuously provide care in all stages of patients’ lives, and throughout the big and small moments. Continuity is also present in care through the ongoing follow-up carried out to patients, where coordination with other levels of care and health care professionals is crucial. Lastly, continuity represents their constant preparation and skills development, uninterrupted research, and the ability to adapt and build resilience to change, technologies, methodologies, and educational strategies.

Family doctors and primary care professionals are there, wherever and whenever needed. Always at the front line — in war, health crises, and times of peace. They are part of the communities they work with, proactively reaching and engaging with members, sharing their core values, creating a unique connection with their patients, and building bonds of trust.

Delivering accessible, equitable, sustainable, high-quality care is Family Doctors’ raison d’etre. Being a Family Doctor is both a privilege and a responsibility, always looking after people and providing what is necessary for their welfare and protection, identifying their patients’ needs to guarantee the fundamental right to health.

World Hypertension Day | 17 May

On 17 May, we celebrate World Hypertension Day (WHD), a day dedicated to highlighting the importance of monitoring blood pressure and bringing global awareness to over 1 billion people living with high blood pressure worldwide.

According to the World Health Organization (WHO), blood pressure is the force exerted by circulating blood against the walls of the body’s arteries, the major blood vessels in the body. High blood pressure, also known as hypertension, is when blood pressure is too high.

Hypertension or high blood pressure occurs when the blood pressure rises to an unhealthy level. The disease is very common and develops over a course of years. Narrow arteries cause more resistance and increase blood pressure. This force can cause damage to blood vessels, and lead to heart attack, brain stroke, kidney damage, or nerve damage.

Blood pressure is written as two numbers. The first (systolic) number represents the pressure in blood vessels when the heart contracts or beats. The second (diastolic) number represents the pressure in the vessels when the heart rests between beats. Hypertension is defined as a systolic blood pressure consistently above 140 mm Hg and/or diastolic blood pressure consistently above 90 mm Hg. It is considered to have touched a dangerous level when the blood pressure measurement goes over 180/120.

Around 1.13 billion people around the globe live with hypertension which is a major cause of cardiovascular disease and premature death worldwide. However, only 1 people in 5 have it in control while others still face the risk of developing complications from it. The incidences of hypertension have seen a sharp rise across the world and while earlier it was common in the older age groups, now we get to see many new cases of young people with hypertension.

High blood pressure is called a silent killer not without a reason. Most of the time, there are no noticeable signs of hypertension and even if you have some symptoms, you may not immediately act upon it dismissing it as routine tiredness, work pressure or exertion. High-stress levels, obesity, poor dietary habits, and a sedentary lifestyle are some of the major causes of hypertension in young people. Prolonged hypertension also puts a person at a higher risk of several medical conditions like chronic kidney disease, stroke, heart failure and others.

The Theme
The theme of WHD for 2022 is Measure Your Blood Pressure Accurately, Control It, Live Longer. It focuses on combating low awareness rates worldwide, especially in low to middle-income areas, and accurate blood pressure measurement methods.

The History
WHD was first inaugurated in May 2005, and ever since it has become an annual event. The main purpose behind the celebration of the WHD is to promote public awareness of hypertension and to encourage citizens of all countries to prevent and control this silent killer, the modern epidemic.

The Significance
The day focuses on creating effective communication about the importance of raising awareness on the early diagnosis of high blood pressure and avoiding complications of advanced stage complications.

There are some factors that cause hypertension that we cannot control, which include age and a family history of hypertension. However, leading a healthy life may prevent hypertension.

Rehabilitation Interventions

Increasing numbers of patients are surviving critical illnesses, but survival may be associated with a constellation of physical and psychological sequelae that can cause ongoing disability and reduced health-related quality of life. Limited evidence currently exists to guide the optimum structure, timing, and content of rehabilitation programmes. There is a need to both develop and evaluate interventions to support and expedite recovery during the post-ICU discharge period.

If we consider the definition of rehabilitation as “a set of measures that assist individuals who experience, or are likely to experience, disability to achieve and maintain optimal functioning in interaction with their environments”, then rehabilitation is in effect composed of multiple components or “interventions”.

Most individuals participating in rehabilitation require interventions addressing one, many factors that are contributing to reduced functioning, with the overriding goal of rehabilitation being to utilise appropriate interventions that allow the individual to optimise their function.

The timing and type of intervention that a rehabilitation provider selects depend greatly on several factors which include: the aetiology and severity of the person’s health condition; the prognosis; the way in which the person’s condition affects their ability to function in their environment; as well as the individual’s identified personal goals and what it is they want to achieve from the rehabilitation process.

Different rehabilitation settings may vary in their capacities to provide specific intensities of therapies, and rehabilitation itself may vary in its intensity, generally measured by the frequency and duration of individual interventions or treatment sessions. The selection of rehabilitation interventions and intensity of rehabilitation should always be based on the individual patient’s needs, which should include their tolerance of therapeutic activities.

More importantly, rehabilitation interventions should be generally outcome-oriented, in that rehabilitation goals are developed to achieve a specific outcome that is based on the following five broad areas:

  • Prevention of the loss of function
  • Slowing the rate of loss of function
  • Improvement or restoration of function
  • Compensation for loss of function (compensatory strategies)
  • Maintenance of current function

Rehabilitation intervention is provided across the whole range of healthcare settings including the primary care setting, in the acute hospital setting (during an inpatient episode or as an outpatient referral) or in the community settings. The breadth of rehabilitation means that a range of organisations may contribute to meeting a person’s individual needs.

Rehabilitation interventions are hugely diverse and, except in rare instances, require the involvement of many different health and rehabilitation professionals and cross multiple disciplines often at the same time, which as a result make the classification of rehabilitation interventions quite complex. It is this complexity that makes the classification of rehabilitation interventions a challenge, and as a result, there is still no classification that has been universally accepted across all fields of rehabilitation currently, despite several attempts made to develop a classification system to fully describe rehabilitation interventions.

The success of most, if not all, rehabilitation interventions is entirely dependent on the commitment and engagement of the people receiving the service. For example, assistive technology or strength training is irrelevant if the person does not want to use the device or undertake exercises. Therefore, rehabilitation requires some level of patient motivation and adherence to be effective.

H/T Physiopedia

Home Care Isn’t Home Healthcare

People often think home healthcare and home care are the same things. The terms sound similar and both types of care are delivered in the home. But there are important differences between home care and home health care.

Home Health Care

The home health care definition is medical services provided at home to treat a chronic health condition or help you recover from illness, injury or surgery. Some people start home health care after a health decline or getting diagnosed with a serious medical condition. Many people transition to home health care after a stay in a hospital, rehab centre or skilled nursing facility. The primary goals are to help people recover and stay as independent as possible. Home health care is usually less expensive, more convenient, and just as effective as care you get in a hospital or a nursing home.

The range of home health care services a patient can receive at home is limitless. A doctor may visit a patient at home to diagnose and treat the illness(es). He or she may also periodically review the home health care needs. Home health care services address intermittent, or periodic, needs and also includes:

  • Nursing
  • Physical therapy
  • Speech therapy
  • Occupational therapy
  • Medical social work
  • Wound care
  • Patient and caregiver education
  • Help with daily tasks like bathing and dressing from a home health aide.

Home Care

The definition of home care is helping with daily activities to allow people to stay safe at home. It is often used by older adults with chronic illness, those with disabilities and people recovering from surgery. Home care is also sometimes called personal care, companion care, custodial care or homemaker services.

Home care services may include:

  • Bathing, toileting, dressing and grooming
  • House cleaning and other chores
  • Transportation
  • Meal preparation
  • Companionship
  • Medication reminders.

Home health care provides “clinical” or “skilled” care by qualified doctors, licensed nurses and therapists whereas homecare provides “non-clinical” or “non-skilled” care by professional caregivers.

Although there are many differences between home care and home health care, both types of care can help older adults stay safe and independent in their homes. Home healthcare provides clinical care to help the patient recover, and home care helps with day-to-day caregiving and tasks.

We have started a new initiative — Ayurdad — to provide home healthcare services in and around Ranchi, Jharkhand (India). We, a team of doctors, are visiting the patient’s house on-call providing quality medical services at the comfort of their homes.


Every year, around the world, between 250,000 and 500,000 people suffer a spinal cord injury (SCI). People with a spinal cord injury are two to five times more likely to die prematurely than people without a spinal cord injury, with worse survival rates in low- and middle-income countries.

At our Neurosurgery department at Bhagwan Mahavir Medica Superspecialty Hospital in Ranchi, I was discussing with my colleagues, Dr. Amar and Ms. Shayanti on how to apply neuroprosthetics in treatment of impaired brains. We discussed many futuristic options, which would revolutionize the management of impaired brains and SCI cases.

The impaired brain is often difficult to restore, owing to our limited knowledge of the complex nervous system. Accumulating knowledge in systems neuroscience, combined with the development of innovative technologies, may enable brain restoration in patients with nervous system disorders that are currently untreatable.

Where once prosthetics were crude and simplistic, now they’re carefully engineered works of art. In fact, with breakthroughs such as neuroprosthetic limbs, there’s even the potential for prosthetics to interface with the human brain.

As the name suggests, neuroprosthetics combines neural processing with prosthetics. Neuroprosthetics, also known as brain-computer interfaces, are devices that help people with motor or sensory disabilities to regain control of their senses and movements by creating a connection between the brain and a computer. In other words, this technology enables people to move, hear, see, and touch using the power of thought alone.

Although some neuroprosthetics, such as cochlear implants and visual prosthetics, have been around since the 1950s, they are just beginning to emerge as viable interventions in the field of brain injury. Neuroprosthetics encompass a variety of artificial devices or systems that can be used to enhance the motor, sensory, cognitive, visual, auditory, and communicative deficits that arise from acquired brain injuries. These include assistive technology, functional electrical stimulation, myoelectric prostheses, robotics, virtual reality gaming, and brain stimulation.

Implanted neuroprosthetics and neuroelectrode systems have been under investigation for a number of decades and have been proven to be safe and efficacious as treatments for several neurological disorders as well as for biosensor systems. Neuroelectrode technologies are typically fabricated from metallic conductors, such as platinum, gold, iridium, and their oxides, materials that while chemically inert and excellent electrical conductors are often not intrinsically cytocompatible and do not promote integration with neural tissues.

A brain-computer interface (BCI) relies either on a chip implanted in the user’s brain or electrodes placed upon the scalp. That way signals from the brain may be read by the prosthetic device itself. The BCI is an input/output device that bridges the brain and prosthetic devices. The same signals that would control an organic limb fire, and thus perform the desired function. The signals may be sent via electrodes on the scalp, the brain’s surface, peripheral nerves, and embedded within the brain. Depending on the type of electrodes used, it’s a pretty simple procedure or rather invasive implantation.

But it’s not as simple as hooking up a BCI and connecting everything. Rather, brain imaging is first necessary. Mapping the brain provides intent into what a brain signal means, and how the body is supposed to respond accordingly. Artificial intelligence can expedite this process. Still, there’s definitely a learning period wherein calibration is required.

Moe Long has aptly said prosthetics, both neuroprosthetics and otherwise, have evolved greatly. Even a prosthesis that allows for running is a massive improvement from where the field began. Yet now brain-computer interfaces have been successfully implemented. A paraplegic man, for example, pulled off the first World Cup kick with a neuroprosthesis. Similarly, a Roman woman began using a BCI-powered hand that even senses touch. Once the subject of science fiction, neuroprosthetics have seeped into the mainstream with field-tested hardware. Expect the accuracy and ease of implementation to only improve.

Long COVID | Lasting Illness After Recovery

Long COVID a.k.a. post-COVID-19 syndrome, post-acute sequelae of COVID-19 (PASC), chronic COVID syndrome (CCS) and long-haul COVID is a condition characterized by long-term sequelae — appearing or persisting after the typical convalescence period — of coronavirus disease 2019 (COVID-19).

Earlier in the pandemic, it appeared that the majority of people infected with the coronavirus experienced mild-to-moderate symptoms and generally recovered within two to three weeks, depending on the severity of their illness. However, as time has passed, it’s become clear that some people, regardless of the severity of their disease, continue to experience symptoms beyond the acute phase of infection. This has become known as “long COVID”.

Long COVID is a patient-created term that was reportedly first used in May 2020 as a hashtag on Twitter by Elisa Perego, an archaeologist at University College London.

Long COVID has no single, strict definition. It is normal and expected that people who experience severe symptoms or complications such as post-intensive care syndrome or secondary infections will naturally take longer to recover than people who had mild illness and no such complications.

One rule of thumb is that long COVID represents symptoms that have been present for longer than two months, though there is no reason to believe that this choice of cutoff is specific to infection with the SARS-CoV-2 virus.

Most people who catch COVID-19 won’t become severely ill and get better relatively quickly. But significant numbers have had long-term problems after recovering from the original infection — even if they weren’t very ill in the first place.

Post-COVID conditions are a wide range of new, returning, or ongoing health problems people can experience four or more weeks after first being infected with the virus that causes COVID-19. Even people who did not have COVID-19 symptoms in the days or weeks after they were infected can have post-COVID conditions.

These conditions can have different types and combinations of health problems for different lengths of time.

According to Centers for Disease Control and Prevention (CDC), some people are experiencing a range of new or ongoing symptoms that can last weeks or months after first being infected with the virus that causes COVID-19.

Unlike some of the other types of post-COVID conditions that only tend to occur in people who have had a severe illness, these symptoms can happen to anyone who has had COVID-19, even if the illness was mild, or if they had no initial symptoms.

People commonly report experiencing different combinations of the following symptoms:

  • Difficulty breathing or shortness of breath
  • Tiredness or fatigue
  • Symptoms that get worse after physical or mental activities
  • Difficulty thinking or concentrating (sometimes referred to as “brain fog”)
  • Cough
  • Chest or stomach pain
  • Headache
  • Fast-beating or pounding heart (also known as heart palpitations)
  • Joint or muscle pain
  • Pins-and-needles feeling
  • Diarrhoea
  • Sleep problems
  • Fever
  • Dizziness on standing (lightheadedness)
  • Rash
  • Mood changes
  • Change in smell or taste
  • Changes in period cycles

The respiratory tract is the site of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) entry and infection; however, COVID-19 is a complex systemic disease, affecting the cardiovascular, renal, hematologic, gastrointestinal and central nervous systems. As evidence emerges of predominantly lasting impairment of lung function related to fibrosis, more data on the long-term effects of COVID-19 on other organs are required.

Researchers don’t know why symptoms linger but believe some symptoms reflect lung scarring or damage to other organs from severe initial infections. Another theory suggests that the virus may linger in the body and trigger an immune response that leads to the symptoms.

Multi-organ effects can affect most, if not all, body systems, including heart, lung, kidney, skin, and brain functions. Autoimmune conditions happen when your immune system attacks healthy cells in your body by mistake, causing inflammation (painful swelling) or tissue damage in the affected parts of the body.

There is currently no test – instead, it is currently a “diagnosis of exclusion” with doctors first ruling out other possible causes. After a year and a half, the risk of long COVID is one of the pandemic’s biggest and least-addressed unknowns.

Some estimates indicate about 30% of unvaccinated COVID-19 patients develop long-term symptoms, including shortness of breath, fatigue, difficulty concentrating, insomnia and brain fog. Similar symptoms can develop after other viral infections, too.

The best way to prevent COVID is by getting vaccinated against COVID-19 as soon as you can. Avoid physical contact and don’t forget to use masks in public places.

Roughly half of the people with long COVID reported an improvement in their symptoms after being jabbed – possibly by resetting their immune response or helping the body attack any remaining fragments of the virus, say experts.

Vaccination can also help prevent people from contracting the virus and developing long COVID in the first place. Using masks in public places are to be continued as a practice even after vaccination. We need to continue to follow the COVID appropriate behaviour.

Past pandemics have led to changes in the way we live that we’ve come to accept as normal. Screens on our doors and windows helped keep out mosquitos that carried yellow fever and malaria. Sewer systems and access to clean water helped eliminate typhoid and cholera epidemics. Perhaps the lessons learned from COVID-19 might yield similar long-term improvements in our health system.

Awareness Means Life | Life is Precious

It was in the year 2018 when I just completed my MBBS internship and had the honour to be invited to a National Seminar held on Hemorrhagic and Ischemic stroke on the campus of Sikkim Manipal Institute of Medical Sciences (SMIMS) in Gangtok, Sikkim by the chief organizer of the event – Dr. Gorkhi Medhi, MD, DM, Interventional Radiology and Neuroimaging, Assistant Professor Radiology, SMIMS on April 13, 2018.

The seminar started with the lighting of the ceremonial lamps and Saraswati Vandana. Dr. Sharath K.G.G., MD, DM, Consultant Diagnostic and Interventional Neuroradiologist, Apollo Hospitals mentioned about the basics of stroke in his introductory speech.

A stroke is a condition of short supply of blood to a part of brain, which could be due to hemorrhage or blockage.

The speakers started deliberating on how the stroke happens in many people with different reasons and with unpredictable signs and symptoms based on their experiences with their patients. The latest advancement the Specialists made in managing the patients were discussed.

Traditionally, such cases were managed by neurosurgeons by opening the skull — craniotomy. Since the nineties, interventional radiologists have developed an innovative method by puncturing a single hole in a deep vein (most preferably – Femoral) a.k.a. catheterization and completing the entire procedure guided by Computerised Tomography (CT) inside a catheterization laboratory or cath lab. The new procedure is faster, less pain-inflicting, cost-effective and with quicker recovery time.

The seminar ended with discussions on lack of knowledge about the stroke among the population and therefore it’s quite important to create general awareness among the patients and their kith and kin so that the patients could be diagnosed and treated in time with least or no irreversible damage.

Patients who arrive at the emergency room within 3 hours of their first symptoms often have less disability 3 months after a stroke than those who received delayed care.

There is an effective way that non-medical associated people should follow for any High-risk patients (as listed below) — commonly called: F.A.S.T. The FAST was developed in the UK in 1998 by a group of stroke physicians, ambulance personnel, and an emergency room physician.

Face – To check for any drooping of the face
Arms – To check for any weakness in arms
Speech – To check for any slurring of speech
Time – If any/all symptoms are present in the patient then its time to call emergency

High-risk patients: Patients with

  • Old age
  • Hypertension
  • Diabetes
  • Hyperlipidemia, or high cholesterol
  • Long-standing unattended Deep Vein Thrombosis
  • History of Embolism
  • History of Loss of consciousness
  • History of previous occurrences
  • History of atherosclerosis

Regardless of your age or family history, a stroke doesn’t have to be inevitable. Stroke is a medical emergency. Let’s spread the message: Think FAST. Act Fast.