Factors affecting EMR Adoption, Use and Data Quality

Article: 

Physician user satisfaction with an electronic medical records system in primary healthcare centres in Al Ain: A qualitative study

Alawi, S. A., Dhaheri, A. A., Baloushi, D. A., Dhaheri, M. A., & Prinsloo, E. A.

1. What are the key points of the article? 

The article discusses the strengths and weaknesses of an Electronic Medical Record (EMR) called Cerner which is deployed on rural areas of a highly developed country in the United Arab Emirates. Cerner Solutions is a medical software company based on Australia. It has a range of applications from critical care to primary care among others.  

(1)Cerner® solutions enable physicians, nurses, and other authorized users to share data and streamline processes across an entire organisation. An online “digital chart” displays up-to-date patient information in real time, complete with decision-support tools for physicians and nurses. Simple prompts allow swift and accurate ordering, documentation, and billing.

The company was awarded by Al Ain, Abu Dhabi as their EMR and was implemented last 2008.  A complete suite (patient-centered modules, labs, referral and reports) was implemented in these Primary Health Centres. 

In this study, the satisfaction of the physicians interviewed were gathered and summarized into themes, mainly: 1) Physician-dependent factors, 2) Patient-related outcomes, 3) System-dependent factors and 4) Suggestions. The themes were further specified and dissected in this table (2):

Physician- dependent factors

The table provided us a bird’s eye view to extract the advantages and disadvantages of having paperless / less-paper systems. Based on the Physicians’ answers, adopting the system in the beginning is difficult. Computer skills aspect was a major setback especially with aged doctors (but not all) experience technology gap. However their perception of the system’s usefulness reflected in the study.

Patient-related outcomes

The doctor- patient relationship was affected since the eye to eye contact was decreased. Waiting time for the patient has lengthened according to the responses. This is an opposite of what an electronic method is promising. However, patient acceptance was noted by the physicians.

System-dependent factors

This factor was the bulk of the responses. Important factors were considered here like:

Positive themes

a. Good quality documentation (inserting the Good Quality Data as identified by the WHO)

b. Prescription is much better

c. Decreased errors especially on medications

d. More organized orders and results

e. Referral system is easy

Negative themes

a. Complexity of the system affects use

b. Compatibility of the system with the facility’s operations

c. Takes (Time on encoding is longer, loading spinners)

d. Confidentiality of patient is at risk.

2. What lessons learned does it describe?

Four (4) key points to describe the lessons that I’ve learned from the article

Systems strive hard to achieve perfection

There is no such thing as a perfect system. Even though Cerner is an established company and there are a hundred to a thousand dedicated developers, however, it cannot fully determine how the system behaves based on some factors. There are very minor loopholes which can create massive damages when given the opportunity.

Integrate with the facility’s workflow

Workflow integration is crucial. This will dictate the usability of the system, it’s ease of use and how will it be adopted.  When deploying a system to a facility, consult and develop the system together with the health workers who will use it.  

    

Satisfy your customers

End-user suggestions are very important. The lessons learned in the first implementation combined with user experience are a good precursor of a better system. Additionally, provide optimum user support. Health workers, though others can be tech savvy, have many responsibilities aside from encoding data in the system. Technical support is an enabling factor to consider when it comes to usability.

Protect your patients

The local or the cloud database can be compromised at times. Always consider the threats for patient confidentiality and privacy to alleviate the need for legal countermeasures and patient and user distrust.     

3. How can this relate to the local setting in the Philippines?

There are similarities between the case of Al-Ain and the Philippines. First, like Al-Ain in 2008, the Philippines is now into manual to electronic-based transition. The difference however, given the challenges of our geography and dialects make, we have a lot EMR’s who are already deployed unless all are amenable to have a sole EMR that will be used nationwide. The problem will manifest when the Government decides to unify all health records and I think we are a bit late on this. To mitigate this, the country launched its advocacy for interoperability (PHIE) however a great deal of time is needed to settle the issues. A lot of aspects should be considered: Connectivity, Electricity and budgetary problems for the recipients while business, politics and legacy for the implementers.

Second similarity would be the technology adoption. Age may not be a factor for some but for me, it does matter. As an EMR implementer myself, I’ve encountered a lot of aged health workers who are laggards when it comes to technology adoption or are having difficulties in using devices (computers, mobile phones, etc.). A thorough and intensive training is required to alleviate this problem. Another measure would be  to select a champion in a form of the facility’s manager/leader, who will steer his/her staff to use the system. A robust end-support should also be established to counteract the problems with ease of use and system usability.

System implementers should be visionaries. They should always think 2 steps forward. Risk management while still on the conceptualization stage would greatly benefit the deployment. From the workflow design to hardware specifications, identification of the possible issues and their corresponding interventions is important. In this way, problems about confidentiality and workflow compatibility are lessened. Sometimes the government lacks these traits, making them vulnerable to conduct unpolished systems. In the end, user and patient satisfaction will mainly suffer as a consequence. 

Sources:

(1)   http://www.cerner.com/solutions/Hospitals_and_Health_Systems/.Accessed January 27, 2016,

(2)   Alawi, S. A., Dhaheri, A. A., Baloushi, D. A., Dhaheri, M. A., & Prinsloo, E. A. (2014). Physician user satisfaction with an electronic medical records system in primary healthcare centres in Al Ain: A qualitative study. BMJ Open, 4(11). Retrieved from http://bmjopen.bmj.com/content/4/11/e005569/T2.expansion.html