MOH reported that there are nearly 1,500 public hospitals, over 380 private hospitals, and nearly 70,000 private clinics in Vietnam.

Under MOH’s Circular 46 released in 2018, all Grade-1 hospitals have to use electronic medical records by the end of 2023. But only 100 hospitals have announced their transition to this type of medical record (more than 30 Grade-1 or higher ranked hospitals.

"The figures are below expectations," MOH said at a workshop to finalize the draft circular guiding the implementation of electronic medical records held in October. 

Though these 100 hospitals "do not use paper medical records," in reality, many healthcare units still use both types of medical records.

Thanh Son District Medical Center in Phu Tho Province is a Grade-2 health unit with 500 beds. According to the center director, Nguyen Thi Ngoc Hoa, the center officially began using electronic medical records in 2022. Currently, all medical records are stored in their information system. But the hospital still keeps paper records because many documents, forms, and sheets require patients’ ‘wet’ signatures. So, both paper and electronic medical records are still being used.

Hoa said previously, a paper medical record could contain up to 50-60 A4 sheets, but now, there are only 4-5 papers. 

"Every year, the medical unit provides inpatient care to about 22,000 people, and if the medical facility still used paper records, there would be 1.1 million papers. With electronic medical records, the number of printed papers is just 1/10 of that," said Nguyen Huu Hoang from the Thanh Son District Medical Center.

Similarly, Phu Tho Obstetrics and Pediatrics Hospital began using electronic medical records but still needs paper records as some significant documents need patients’ signatures to meet legal requirements.

Managers of both Phu Tho Obstetrics and Pediatrics Hospital and Thanh Son District Medical Center said that the shift from developing X-ray films to digital techniques and digital storage on Picture Archiving and Communication System (PACS), is major progress and reduces the volume of film developer liquid, a hazardous liquid waste generated from film processing, and minimizes ink and paper waste or plastic waste from X-ray, MRI, and CT images discharged to the environment.

Bui Trong Quynh, deputy director of Phu Tho Obstetrics and Pediatrics Hospital, said that digital transformation can help save money on printing papers, save storage capacity, reduce expenditure on electricity bills and dehumidifiers, and reduce the cost of destroying expired medical records. Also, it helps reduce dust and thus pollution.

In general, all hospitals and medical facilities using electronic medical records affirmed that e-records and PACS help make hospitals ‘cleaner’.

Electronic records still need print films

Phu Tho is a leading province in Vietnam in terms of number of health units using electronic medical records. However, like other localities, local hospitals using PACS still have to print films, because if they don’t do this, they won’t get paid from the social insurance agency. Currently, only Phu Tho General Hospital and Cam Khe District Medical Center, the two units implementing MOH’s pilot project, are reimbursed in full without print films.

As for patients who use medical services without health insurance, hospitals can provide film results through QR Code or print disks.

Hoang from Thanh Son district health center said the unit has to spend VND1.1 billion to import films to print. Meanwhile, in the first 10 months 2024, Phu Tho Obstetrics and Pediatrics Hospital printed over 52,100 X-ray films and more than 3,300 CT and MRI films. The average cost for films is about VND26,000 per film, excluding printing ink and electricity.

Bach Mai Hospital, one of the largest hospitals in Vietnam, has to spend VND70 billion on films of different types, VND3 billion to buy printing ink, and VND4-5 billion to print documents. The hospital can save VND80 billion when using e-medical records.

Some years ago, MOH estimated that the annual expenditure on imaging films for hospitals in Vietnam was about VND2,000 billion. Tran Quy Tuong, President of the Vietnamese Health Informatics Association, said with the use of PACS in Vietnam, the cost is just equal to 50 percent of film value. 

If PACS can be implemented on a large scale, it would not only help medical facilities save money and improve diagnostic quality but also protect the environment by eliminating the need to print films.

Vo Thu