Photo courtesy of Institut Jantung Negara
Malaysia's Institut Jantung Negara (National Heart Institute) has achieved the country's first Stage 7 validation for the HIMSS Electronic Medical Record Adoption Model.
The EMRAM measures an organisation's adoption and maturity of its EMR capabilities.
Founded in 1992, the 433-bed quaternary hospital is the largest cardiac hospital in Malaysia, seeing over 300,000 outpatients with cardiac, thoracic and vascular disorders annually.
Structured preparation
Their preparation for the Stage 7 validation was "a journey of structured planning, collaboration, and strong leadership," according to Dr Alwi Mohamed Yunus, Clinical Director of Health Informatics at IJN.
"Strong stewardship from top management was instrumental in maintaining team cohesion and ensuring vendor commitment," Dr Alwi told Healthcare IT News. Preparation was overseen by the hospital's Information Management Committee and governed by its EMRAM Oversight team led by IJN CEO Professor Dato’ Sri Dr Mohamed Ezani Md. Taib.
Dr Alwi explained that they had to formalise core modules into dedicated subcommittees under the IMC, with each subcommittee led by a clinician and supported by a subject matter expert and IT lead. "This structure enabled us to concentrate expertise, streamline workflows, and drive targeted improvements across all critical areas of our digital ecosystem."
Following its Stage 6 validation, Institut Jantung Negara implemented upgrades to clinical documentation, EMR auditability, system resilience, and governance, including more structured change request processes. It also expanded digital integration across care delivery, including closed-loop medication management, real-time medical device data capture, improved data sharing and interoperability through HIE, and greater use of its IJNCare mobile platform for patient engagement.
Building in-house
One of its main challenges during this process was customising existing systems. "Ensuring all systems worked seamlessly together required careful workflow mapping and targeted adjustments, including embedding comprehensive clinical decision support into the EMR and HIS," noted Dr Rhema Sundram, IJN’s Head of Customer Experience.
Another challenge was implementing multiple single sign-on configurations, which required them to standardise authentication protocols and conduct extensive testing.
IJN also had to build tools in-house where off-the-shelf solutions fell short to connect workflows, fill gaps, and enhance interoperability.
Enhancing ICU outcomes
During their validation, IJN demonstrated how it improved ICU outcomes using digital infrastructure.
In 2021, its operating theatre recorded a 7.6% surgery cancellation rate, largely due to a lack of beds in the ICU. The limited ICU capacity was a result of prolonged patient stays, with an average length of stay of 3.7 days, as well as preventable complications such as ventilator-associated pneumonia (1.7 cases per 1,000 ventilator days) and catheter-related bloodstream infections (3.8 per 1,000 line days).
Although a critical care information system had been in place since 2009, it relied on siloed data with limited integration. It only allowed documentation and retrospective performance monitoring that offered little actionable insight to guide proactive decisions.
As a solution, IJN implemented structured electronic medical record capture and integrated data repositories. Data from multiple sources were extracted and linked using unique patient identifiers through a central data mart, combining records from the hospital information system, critical care information system, and clinical databases such as the ICU registry and surgical risk and operation data.
It also developed dashboards using Microsoft Power BI for tracking trends, drilling down into specific cases, and reviewing performance through executive scorecards. According to Dr Alwi, building these operating theatre and ICU dashboards internally allowed rapid iteration, adaptation to local clinical workflows, and timely incorporation of frontline feedback.
By 2025, the hospital reported marked improvements in operating theatre efficiency and patient outcomes. Dr Alwi shared that overall surgery cancellations fell from 7.6% in 2021 to 3.9%, while cancellations specifically due to unavailable ICU beds dropped from 3.4% to 0.1%.
Clinical outcomes in the ICU also improved, he said. Rates of preventable infections declined, with ventilator-associated pneumonia decreasing from 1.7 to 1.0 per 1,000 ventilator days and catheter-related bloodstream infections falling from 3.8 to 1.7 per 1,000 line days. At the same time, she added, patients spent less time in intensive care, with average stays reduced from 3.7 days to 2.8 days.
Moreover, ICU mortality went down from 7.4% in 2021 to 2.1% in 2025. The drop in preventable infections helped lower complications and deaths and freed up ICU beds to support more surgical cases, Dr Rhema explained.
Efficiency gains
Overall, digitalisation at IJN delivered measurable gains across clinical and operational areas, according to Dr Rhema. Workflows have been streamlined, reducing manual tasks and enabling faster access to patient information at the point of care.
Medication safety has improved alongside reduced prescribing errors. The rate of medication errors reaching patients declined from 3.1 to 2.8 per 100,000 orders, while pharmacists are able to verify prescriptions more quickly. With enhanced detection capabilities, the hospital can quickly identify near-miss medication errors.
In addition, the shift to a fully paperless environment has cut costs and administrative burden. The hospital reported a drop in paper consumption and spending on patient folders and printed clinical forms, alongside reduced reliance on physical record storage and off-site archiving.
Digital workflows have also raised staff productivity, particularly among nurses, by reducing documentation workload and allowing more time for direct patient care.
THE LARGER TREND
Following its Stage 7 EMRAM validation, IJN is now focused on "sustainability, optimisation, and value realisation."
Dr Alwi said they are prioritising the optimisation of existing systems, advanced analytics and AI enablement, and interoperability and ecosystem integration.
He also shared that IJN is exploring other HIMSS digital maturity models, initially looking at the Infrastructure Maturity Model and later the Analytics Maturity Assessment Model.
"Our journey doesn't end at Stage 7," Dr Rhema stressed. "It marks the beginning of a new phase where we scale innovation, deepen impact, and continue positioning ourselves as a leading digital health organisation in the region."
ON THE RECORD
Clinical Director of Health Informatics
Senior Consultant Cardiothoracic Surgeon
EMRAM Program Leader
IJN
"Achieving Stage 7 of the HIMSS EMRAM represents the highest level of digital maturity for a healthcare organisation. It reflects technology that is fully embedded and enabled in every aspect of patient care, delivering safer, smarter, and more connected outcomes.
"But for us, it means even more. It proves that anything is possible when we set our minds to it – driven by sheer determination and a shared purpose. This is part of the IJN DNA; when we commit to a goal, we pursue it relentlessly because we believe the sky is the limit.
"This belief carried us from EMRAM Stage 0 to Stage 6 in just 12 months (November 2024) and 15 months later, to EMRAM Stage 7 (March 2026)."
Head of Customer Experience
EMRAM Clinical Sponsor
IJN
"This achievement not only reflects our digital maturity. It also positions us as a digital leader in the country and the region, setting the benchmark for what is possible in healthcare transformation.
"It is a testament to our people, our resilience, and our unwavering commitment to transform care for our patients."
