The driving question for this week is “What are the issues and challenges in implementing electronic medical record in primary care. This topic is very relevant to me because recently, our specialty society, the Society of Gynecologic Oncologists of the Philippines (SGOP) had a meeting to revisit the defunct electronic tumor registry for gynecologic cancer. As the primary specialty for gynecologic cancer, the society deemed it necessary to have a sustainable and effective tumor registry. Electronic Tumor registry is a health informatics technology similar to Electronic Medical Record since both have the capability to acquire information from patients, which can be used for health statistics and reports. In the discussion of formulating an effective tumor registry or electronic medical record, there are issues and challenges that have to be addressed before starting implementation. This article will discuss important issues and challenges that if addressed will lead to successful electronic medical record implementation.
Status of the existing medical record
This a major factor to know when attempting to shift from manual, paper-based medical record to electronic medical record. If the existing medical record keeping were very ideal in the sense that all end users are contributing to its success, it would be easy to convert to electronic medical record. If the system is haphazardly implemented or strict implementation of the system is only optional for the users, then shifting to EMR will be difficult and be doomed to fail.
Acceptability
Acceptability of healthcare providers is a very important factor and in fact should be the first consideration in EMR implementation because they are the ultimate users of the EMR. Acceptability will stem into resistance to a new technology and the lack of technologic literacy. Resistance to the new systme can be addressed by educating the users the mutiple benefits of shifting to EMR from paper-based record system. Lack of technological literacy can be addressed by doing training and workshops. The system should also provide easy troubleshooting functions that the user will easy to use once problems arise.
Financial capability/Investment of the Institution to start and expand health informatics technology. Paper-based medical record may not require a huge of capital for its implementation but inefficiency in healthcare service and possible medico-legal implication may later add to financial wastage of a system. Health Informatics Technology like EMR can be expensive at the planning stage because it requires multidisciplinary approach. System and database design and development, software, hardware, infrastructure, and human resource training will cost a lot. However, efficiency of the system will translate to good healthcare service that will later lead to higher investment return.
Heterogeneity of users
In a hospital setting, there are many end users that will potentially provide health information. There are different healthcare providers from doctors, nurses and other paramedical staff to non-medical hospital staff. Within the medical staff, there are also different medical specialties with different way of obtaining patients’ data. Medical records from pediatricians are different from Ob-Gyne or Orthopedic surgeons etc… Integrating all specialties in one EMR is a major concern.
Functionality of EMR
An ideal EMR caters to all aspects of healthcare system. EMR should not only deal with the medical aspect, but also nursing, pharmaceutical, laboratory and radiologic, billing services, and admissions and discharges. EMR should integrate all functions of a hospital or health organization. If one function is not included in the EMR system, it will continue to use the paper-based medical record that will hinder success of EMR.
Security and Confidentiality
This is another important issue to discuss. It is the healthcare providers’ responsibility to take care of the data gathered from patients. And since majority of end users are not technically literate when it comes to security and confidentiality, it is only understandable for the fear of data breach. A good EMR should have multiple layers of security without compromising data sharing with concerned healthcare providers.
There are other issues that have to be dealt with in the planning and implementing EMR. All these issues have to be addressed for the EMR and the system to run smoothly.
The Adventures of Mang Tomas 