In my previous blog article about electronic medical record last year entitled “Electronic Medical Record: The Now and Future of Healthcare Service”(1)
I summed up the barriers in the implementation of EMR into 5 factors:
- Acceptability or the lack of it of end-users most especially the doctors
- High cost of the system
- Heterogeneity of users
- Complexity of functionalities of EMRs
- Security and Confidentiality
One year after that article, my views on why electronic medical record is still far from full implementation in the country remain the same.
Barriers in the Implementation of EMRs
The Non-acceptance of doctors to use EMR is a mixture of factors that stem from the fact that EMR is a new technology.
– Time to learn the system
– Time to enter data
– EMR eats up time supposedly for patients
– Time to convert records
In an article by Menachemi and Collum (2), EMR causes disruption of workflow of medical staff leading to temporary loss in productivity. Since EMR is a new technology, it requires time for users to get used to it. It needs training that requires time as well. A busy doctor does not have time to learn new system especially if the benefits of such new technology are not known to him. Like in any other system, the more you use the system, the faster you get to use it. Doctors are not willing sacrifice their time especially with their patients to learn new technology. Majority of doctors in the Philippines are still using paper-based medical record. With their numerous patients, it is difficult to know when and where to begin converting the paper-based database into electronic one. In addition, not only doctors but also nurses feel that EMR is taking their time with the patients. Kossman et al reported that nurses feel that EMR slows down their activities, interferes with their ability to efficiently manage time and decreases time with patients (4).
- Security and Confidentiality. With numerous news that reported online hacking of different international and local government agencies [e.g US Army Website Hacking (3), COMELEC Website Hacking (4)], people are very concerned with data cybersecurity. Security and Confidentiality has been a major reason for doctors not to start implementation of EMR. In every discussion about EMR, security and confidentiality has always been questioned.
3. Change Process. Healthcare providers have strong resistance to change (6), leading to non-implementation of EMRs. One of the reasons for this is that many healthcare providers are not aware of the benefits of EMRs. Another reason is the lack of political will, legislation, national policy to use of EMR. People are still not using EMR because they are not mandated to use it. At present, there is still no law or policy that requires all doctors to use EMR in their clinics.
- Electronic Medical Record: The Now and Future of Healthcare Service http://bit.ly/2gkowhi
- Menachemi, T. Collum. Benefits and drawbacks of electronic health record systems. Risk Management and Healthcare Policy. May 2011 DOI: 10.2147/RMHP.S12985)
- Kossman, S. Scheidenhelm. Nurses’ Perceptions of the Impact of Electronic Health Records on Work and Patient Outcomes. CIN: Computers, Informatics, Nursing 2008. Vol. 26, No. 2, 69–77
- Electonic Health Records. AManual for Developing countries. World Health Organization 2006