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Semester 2,

2013 / 2014

ADVANCED DATABASE

INFO 4102

TERM PAPER

Topic: Implementation of Electronic Health Records (HER) in developed and developing countries.

Lecturer: Dr. Mira Kartiwi

Group Members:

Nabila binti Mahmond Saidek (1114920)

Hashmatullah Khalilu Rahman (0933115)

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Content Page

- Abstract page 2

- Introduction page 2

- Significant prior research page 5

- Conclusion page 6

- References page 8

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Abstract

The advancement of the Information and Communications Technologies (ICT) can be seen in almost every sector, be it the government sector, financial sector, publication sector and more. However, the health sector seems to not be making enough use of the benefits that we can gain from ICT when cultivated into the health sector.

This statement can be supported by a survey that was done on hospitals in the United States. From the responses of 63.1% hospitals surveyed, only a staggering amount of 1.5% of those hospitals actually uses electronic health records systems. Another survey done found that only 17% of U.S. hospitals has a computerized order entry for medications. It was also found that hospitals in the urban areas and teaching hospitals are the hospitals that are more likely to have electronic health records systems.

Introduction

Problem Background

Building new hospitals with concrete and compatible infrastructural system guarantee improvement for peoples’ health care. According to M. Fauzan Noordin, societies have gone through number of stages such as agricultural where land was a key resource, industrial society where physical assets such as steel and factories are the resources. But in this current era, information and knowledge are the crucial resources.

Meanwhile, hospitals excessively deal with data processing and transition. Therefore, information system is required to be embedded into hospital to overcome the pressing challenges, which is usually electronic health records system (HER). This fact is further supported by William M. Tierney et al.(2010) where they insisted that for both developing and developed countries sufficient information in hand is the key to manage the health system. Furthermore, financial factors put great positive effects toward success of Electronic Medical Records systems (Jdh et al., 2009). These factors are effective when government shows interest invest (Izzatty & Hazana, 2011).

Purpose and Contents of Our Paper

Information and Communications Technologies (ICT) can be a lifesaver if used rightly, especially health information technology. Under health information technology, there is a field that is known as electronic health records. Electronic health records can be used to access and store information regarding patients and it can also create a whole new platform of health sector. Electronic health records has the potential to improve the time of delivery of services to patients and with this, patients will receive a more efficient service from their service care provider.

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Since Electronic Health Records systems is the future trend of hospital, so it is appearing as a necessary element of health care sector (Tierney et al., 2010). Thus, the purpose of this study is set to determine challenges faced when implementing Electronic Health Records Systems, advantages of the Electronic Health Records systems and elements that could possible affect the performance, effectiveness and the efficiency of Electronic Health Records systems.

This paper talks about how ICT is being used in the health sector, the implementation of electronic health records, the good and the bad based on the reports of it being implemented in several countries such as the United States of America, Finland, England, Malaysia and other developing countries.

The Specific Issues or Questions Addressed in the Paper

The paper, Use of Electronic Health Records in U.S. Hospitals, published by The New England Journal of Medicine had examined the relationship of the adoption of electronic records in the hospitals along with factors that were reported to be barriers to the implementation. It is found from the survey that the reason why most hospitals are still going with the manual system is mainly because of inadequate funds (74%), high maintenance costs (44%), resistance from doctors and physicians themselves (36%), unclear return on investment (32%) and lack of staff that is experienced enough to handle information technology related things (30%). However, it was also found that hospitals that had adopted the Electronic Health Records system didn’t find most of those factors as a barrier except for doctors and physicians resistance. In additional to that, hospitals that have adopted the system found that it has a positive effect on its financial statement. It was also addressed in the paper that the other potential barrier that might exist when adopting this system is that there is a concern about interoperability; that is to allow the sharing and exchanging of data between health care institutes, hospitals and clinics.

The paper, Definition, structure, content, use and impacts of electronic health records: A review of the research literature, by the International Journal of Medical Informatics highlights a point that wasn’t highlighted by other papers that is how the Electronic Health Records system is constantly changing. With the advancement in the field of Information Technology, things changes at a rapid pace and this is what that is happening to the Electronic Health Records systems too. It is changing and this means that doctors and physicians and nurses would constantly need to be taught and trained on how to use the newly revised system.

The paper, Predicting the Adoption of Electronic Health Records talks about how there are two factors that affects the adoption of Electronic Health Records, they are external factors and internal factors. The external factors talks about the costs of the technology itself and all other costs involved such as the operational cost and the maintenance cost. Meanwhile, the internal factors talks about educating the users of the system which includes doctors and physicians and nurses to make them IT savvy enough to use the system.

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Scope and Limitation of the Paper

The present study had only examined implementation of Electronic Health Records in both developed and developing countries and the challenges it faced and the benefits it provides for the societies.

Another limitation of this study was that it didn’t cover all hospitals. Hence, there might be some biasness in the reports. Apart from that, most of the paper focused on the adaptation process of the electronic health records, but did not talk about the actual usage of the system itself. The study also hadn’t indicate whether the users of the system, the doctors and physicians themselves were actually happy with the system.

Usefulness of the Paper

The usefulness of this paper resides in determining the lessons learned from implementing the electronic health records system in developed and developing countries.

Significant Prior Research

What Other have Found or Proposed that is Relevant to Our Work

It is found that previous work done by others includes the general introduction to the framework of Electronic Health Records systems and the challenges and benefits when implementing the Electronic Health Records systems. Although the research was about developing countries, some papers have also include that hospitals in low income countries should use open-source software’s as it is the best choice for them.

It is believed that obtaining the support of doctors and physicians would ease in the process of adoption of the system.

What is lacking in their Research

It is found from the papers that the papers lack one thing that is no extensive research on information technology project management, project scope and project team development was actually conducted. Plus the return on investment was rarely studied by the researchers.

Summary of the Prior Research

A summary of the first paper studied, Use of Electronic Health Records in U.S. Hospitals, concluded that the levels of adopting electronic health records in general were very low, even in developing countries themselves. Higher levels of adoption was

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seen the most in urban areas and in teaching hospitals. This is because they received more funds from the government.

To summarize what others have found so far is as follow:

To remove the inefficiency in hospitals, EMR systems are key solution. Another important contribution of prior research is that software that is easy to use put positive impacts on users (physicians and patients) and thus motivates them especially if its interactive to them .furthermore, prototype of the system is better to be tested on small group of people (sample) rather than on national level (population). The main concern raised prior to implementation of EMR system in hospitals was the cost-related issues. This was further followed by technology-related problems, human-related, legal-related. Finally, the summary of prior research has pointed out government’s active role as central to the success of EMR in a country.

Create incentives to information technology staffs, provide training to these staffs and provide more financial support to these hospitals.

However, there are a few limitations and risks to the implementation of electronic health records. Among some of the limitations and risks covers includes technical risk, administrative risk and also human resource issues.

The main barrier of implementing electronic health records is that it has a high maintenance cost. This is because of the rising cost of living that is happening globally. Apart from that, inconsistent quality of services also seems to be another limitation that arise from the paper studied. It was also found that despite all of the consensus on the potential benefits of electronic health records, it is still found that the U.S. health care providers has been very slow in adopting the system.

In additional to that, there is a concern of its information being misused, concerning data protection and security issues.

Conclusion

A Brief Summary of the Paper

Cost is considered as greatest challenge when implementing the EMR system. Costs are related to hardware, maintenance, and training. Physicians (especially those who were old with no IT background and female) find it hard and complex and thus time consuming when interacting with EMR system, so they quit using it. Another obstacle is the complexity of hardware and software utilization and lack of technical support to overcome technical issues. Meanwhile, confidentiality of the patients’ data is of same concern. EMR system provides good quality of life by making the services more efficient and effective, and the availability of patient’s data to physicians at any instance. The difference of issues between hospitals which had already installed EMR systems and those which had no EMR installed was noticeable where hospitals with no EMR system suffered from all above mentioned issues while hospitals having EMR already installed the physician’s

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resistance was still an anxious matter. Networked EMRs (Distributed databases) make the data accessible from different locations. Internet enabled EMR systems can handle remote locations. Accordingly, there are number of open source EMR systems which have so far benefited great deal of people around the world. The following are the advantages that most of the researchers have found:

Eliminates labor of transporting papers or even scanning or faxing papers.

Improve legibility of clinical notes

Decision support for drug ordering is provided

Remind and warn the patient about their drug to be described and abnormal results to be shown.

Program for monitoring budget, supply, and outcomes

Save time(by having access to extensive amount of information and knowledge)

Save money

It is also found that to ensure a proper adaption to the Electronic Health Records system in a certain country, it should be done step-by-step. For example, first concentrate on teaching hospital and hospitals in urban areas then second phase should include hospitals in rural areas.

Additionally, to implement Electronic Health Records systems, proper planning has to be done and IT literacy doctors and physicians and nurses are required.

Major Conclusion and Recommendations

This study gives an account of and the reasons for the widespread use of electronic medical record systems in hospitals in both developed and developing countries. Meanwhile, Kalogriopoulos, Baran, Nimunkar and Webster (2008) argued that the cost associated with implementation of EMR is a barrier to developing countries. The following are several recommendations based on the findings and conclusions of the study, here are several recommendations to be considered; EMR projects should be deemed business projects rather than Information technology projects. Further research in this area would be beneficial in; identifying the role and effects of EMR project scope, EMR project management, project team development, technology used, and cost of technology which plays enabling role for EMR system to be installed. Apart from that, it is also found that teaching hospitals adopts the electronic health records system better compared to non-teaching hospitals and private hospitals adopts to the system better compared to public hospitals. Emphasize the Construction / Usefulness of Our Review

This research has shown that large scale of patients will be benefited from implementation of EMR systems. Secondly, when designing the EMR system, users should be consulted

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because System design reflects the needs of users whether doctors and physicians or patients.

The low level of using health information technology simply suggests that it is still a long way to go before electronic health records is implemented successfully.

The usefulness of this review done is that it is found that the use of electronic health records would lead to a more efficient, time-saving and a higher quality care in patients.

References

1. Use of Electronic Health Records in U.S. Hospitals, article of The New England Journal of Medicine.

Author names: Ashish K. Jha, M.D., M.P.H., Catherine M. DesRoches, Dr.Ph., Eric G. Campbell, Ph.D., Karen Donelan, Sc.D., Sowmya R. Rao, Ph.D., Timothy G. Ferris, M.D., M.P.H., Alexandra Shields, Ph.D., Sara Rosenbaum J.D., and David Blumenthal, M.D., M.P.P.

Publication date: 25th of March, 2009.

Page numbers: Page 1628 – page 1638.

2. Definition, structure, content, use and impacts of electronic health records: A review of the research literature, article of the International Journal of Medical Informatics.

Author names: Kristiina Hayrinen, University of Kuopio, Department of Health Policy and Management, Finland; Kaija Saranto, University of Kuopio, Department of Health Policy and Management, Finland and Pirkko Nykanen, University of Tampere, Department of Computer Sciences, Finland.

Publication date: 13th of September, 2007.

Page numbers: Page 291 – page 304.

3. Implementation and adoption of nationwide electronic health records in secondary care in England: qualitative analysis of interim results from a prospective national evaluation, article of BMJ.com

Author names: Ann Robertson, Kathrin Cresswell, Amirhossein Takian, Dimitra Petrakaki, Sarah Crowe, Tony Cornford, Nicholas Barber, Anthony Avery, Bernard Fernando, Ann Jacklin, Robin Prescott, Ela Klecun, James Paton, Valentina Lichtner,

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Casey Quinn, Maryam Ali, Zoe Morrison, Yogini Jani, Justin Waring, Kate Marsden, Aziz Sheikh.

Publication date: 5th of August, 2010.

Page numbers: Page 1 – page 12.

4. MOHAMMAD Fauzan Noordin (2013). ICT and Islam, Kuala Lumpur, Selangor, IIUM Press.

5. Kalogriopolus, N. A., Baran, J,. Nimankar, A.J & Webster, J.G. Electronic Medical Record Systems for developing countries: Review.

6. Cresswell, K.M, Robertson, A., Aziz, A. (2012). Lessons learned from England’s National Electronic Health Record Implementation: Implications for the International Community.

7. Izzatty, N., Hazana, N. (2011). Developing Electronic Medical Records (EMR) Framework for Malaysia’s Public Hospitals.

8. Tierney, W.M., Achieng, M., Bakar, E., Bell, A., Biondich, P., Braitstein, P., Yiannoutsos, C. (2010). Experience Implementing Electronic Health Records in Three East African Countries. 9. Predicting the Adoption of Electronic Health Records by Physicians: When Will Health Care be Paperless?, article of jamia.bmj.com Author names: Eric W Ford, Nir Menachemi and M Thad Phillips. Publication date: Not available. Page numbers: Page 1 – page 8.

* attached with are the copies of the cited journal article.