The
Department of Health is one of the leading offices that advocate the eHealth
perspective. Through the establishment of the eHealth Steering Committee, the
government seriously took the challenge of implementing innovations such as
electronic medical records, mobile health applications and the like. Though
this national strategy proved to be effective, barriers and hurdles are still
imminent.
Change
process is difficult to measure however creates a significant impact. This barrier
includes components such as organizational structure and behavior. Getting the
organization/ facility on board will certainly be a dilemma. Resistance may be imminent for
some especially those entities who are not amenable on drastic changes in
management and operations. However, getting the top level management's (leader/ steering committee) buy-in may resolve the
crisis. In an institution or facility, a leader or a champion (usually
physicians) can be a driving force for adoption and positive behavior towards
the use of any product or technology that changes their norm or work
environment. In an article, it was stated that Physicians’ adoption or avoidance of
the EHR impacts hospitals both in financial sector and quality of care. Physicians,
especially those in private practice, perform a pivotal role in directing where
their patients go for treatment. If a physician decides to renounce his
privileges related to an EHR mandate, the hospital may experience a drop in
revenue.1
For
the behavior component, laggards2
who comprise the 16% of the population (health staff) may not consider the use
of technology during the first encounter and will take time to accept the
system. In connection, age and experience may be considered a major factor in
this area. These factors affect the performance expectancy, effort expectancy, and
social influence and facilitating conditions as stated in the Unified Theory of
Acceptance and Use of Technology (UTAUT) framework.3 To mitigate this, the development of the software
should always include the champions and end-users. Engaging and preparing them
early, may warrant a more rapid acceptance by the system users. To summarize, change
management/ process should be mainly considered, once this barrier is handled,
seamless integration and implementation will follow.
Another
barrier that plagues the continuous deployment of these systems is the financial
aspect. Let us admit that “money’ enables the movement of the project timeline.
The high cost of start-up, deployment and maintenance is seen as a hindrance to
sustainability. A cost estimate made by www.healthit.gov for Software as a
Service (SaaS) type of deployment in the US shows an average $8000 dollars as
yearly cost. A deployment combined with a long term support may cost up to
$58,000, 38% more expensive.4
From this cost study alone, one can figure out the enormous amount of money to
be disbursed. The government can provide all the necessary expenses, however in some instances, it
may be limited or not enough. Expect that the resources may not be channelled accordingly as
prioritization may affect technology related projects.
One
of the many financial factors is the staggered and long process of materials
procurement. This factor directly and indirectly affects the project foundations,
development, implementation and support. An article from the Senate Economic
Planning Office recognized these as a problem by stating this in their August
2008 Policy Brief, stated that government procurement time has an average of 7
months.5 Provided this
situation, a project may suffer and returns a domino effect and again, the
timeline is usually at stake. It may then leads to lower quality of software development
(including the planning and design) then the apparently may affect the entire
operation.
Lastly,
technical will be one of my topmost barriers to consider as these elements may
predict the success/ failure of the EMR in the facility. Having a quick rundown,
this barrier listed these factors:
End-users’
computer skills, complexity of the system, physical hardware and software concerns,
connectivity, lack of infrastructure and technical support.
First
and foremost, infrastructure should be evaluated because this will the backbone of
the EHR/EMR. It should be laid down before anything else. In the 791 Philippine public hospitals6 , there is a big
possibility of encountering facilities with “less to no” ICT infrastructure.
From here, proper resource allocations, policy making (governance) or technical
assistance (last option) may aid as countermeasures. The idea is that the
foundation should be in place before the software will be utilized.
Technical
and organizational factors, including support, are widely acknowledged as
important for successful implementation and promotion of Health Systems effective
use of Health Information Technology (HIT).7
This domain will always be an enabling mechanism of sustainability and
maintenance aside from the upgrades and preventive services. That is why it is
crucial that technical support should be planned ahead, even during the inception phase.
Erasing
the age factor, the usability of the EMR will always depend on the skills of
its end-users. As an implementer, the project team is responsible to assess the
computer competency and assess a viable training plan. Complexity should be
eliminated by creating simple user interface (UI) that is integrated in their
manual-based workflow. User Interface is one early attempt to achieve some
uniformity among health IT UI by collecting empirically validated designs with
descriptions of their qualities and applicable contexts. Continuing and
building on this type of work will allow for the development of intuitive, adaptive
displays with the capacity to effectively support the evolving role of EHRs in
clinical practice.8 However,
technology should always be just an aid to their daily operations; it should
not replace their accustomed system. Connected to the human barrier, the skills
should be enhanced. Short courses for healthcare professionals and continuous
medical education programs should be provided on the subjects of EMRs and health
information management9 during
implementation.
References:
1 Luchetski, J. R. (2009, December). Physician Champion Role in an
Electronic Health Record Implementation, a Case History. Retrieved February 25,
2016, from http://digitalcommons.hsc.unt.edu/cgi/viewcontent.cgi?article=1093&context=theses
2 Diffusion of Innovation Theory. (n.d.). Retrieved February 25, 2016,
from http://sphweb.bumc.bu.edu/otlt/MPH-Modules/SB/SB721-Models/SB721-Models4.html
3 Phichitchaisopa, N., & Naenna,
T. (n.d.). Original article: FACTORS AFFECTING THE ADOPTION OF HEALTHCARE
TECHNOLOGY.Retrieved February 24, 2016, from http://www.excli.de/vol12/Naenna_13052013_proof.pdf
4 Retrieved from: https://www.healthit.gov/providers-professionals/faqs/how-much-going-cost-me.
How much is this going to cost me?. Accessed 2/24/2016.
5 G.H. Ambat and Renard Kayne
Ycasiano. Policy Brief: Plugging the Loopholes of the Philippine Procurement
System. August 2008. Retrieved from https://www.senate.gov.ph/publications/PB%202008-05%20-%20Plugging%20the%20Loopholes.pdf.
6 Health Service Delivery Profile – Philippines (2012). (n.d.). Retrieved
February 25, 2016, from http://www.wpro.who.int/health_services/service_delivery_profile_philippines.pdf
7 Khalifa, M. (2013). Barriers to
Health Information Systems and Electronic Medical Records Implementation. A
Field Study of Saudi Arabian Hospitals. Procedia Computer Science, 21, 335-342.
8 Shachak, A., Montgomery, C., Dow, R., Barnsley, J., Tu, K., Jadad, A.
R., & Lemieux-Charles, L. (2013). End-user support for primary care
electronic medical records: A qualitative case study of users’ needs,
expectations, and realities. Health Systems Health Syst, 2(3),
198-212. Retrieved January 25, 2016, from http://www.ncbi.nlm.nih.gov/pubmed/26225209
9 Electronic Health Record Usability:Interface
Design Considerations. October 2009. Retrieved from https://healthit.ahrq.gov/sites/default/files/docs/citation/09-10-0091-2-EF.pdf
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