scholarly journals Assessing the impact of a primary care electronic medical record system in three Kenyan rural health centers

2015 ◽  
Vol 23 (3) ◽  
pp. 544-552 ◽  
Author(s):  
William M Tierney ◽  
John E Sidle ◽  
Lameck O Diero ◽  
Allan Sudoi ◽  
Jepchirchir Kiplagat ◽  
...  

Objective Efficient, effective health care requires rapid availability of patient information. We designed, implemented, and assessed the impact of a primary care electronic medical record (EMR) in three rural Kenyan health centers. Method Local clinicians identified data required for primary care and public health reporting. We designed paper encounter forms to capture these data in adult medicine, pediatric, and antenatal clinics. Encounter form data were hand-entered into a new primary care module in an existing EMR serving onsite clinics serving patients infected with the human immunodeficiency virus (HIV). Before subsequent visits, Summary Reports were printed containing selected patient data with reminders for needed HIV care. We assessed effects on patient flow and provider work with time-motion studies before implementation and two years later, and we surveyed providers’ satisfaction with the EMR. Results Between September 2008 and December 2011, 72 635 primary care patients were registered and 114 480 encounter forms were completed. During 2011, 32 193 unique patients visited primary care clinics, and encounter forms were completed for all visits. Of 1031 (3.2%) who were HIV-infected, 85% received HIV care. Patient clinic time increased from 37 to 81 min/visit after EMR implementation in one health center and 56 to 106 min/visit in the other. However, outpatient visits to both health centers increased by 85%. Three-quarters of increased time was spent waiting. Despite nearly doubling visits, there was no change in clinical officers’ work patterns, but the nurses’ and the clerks’ patient care time decreased after EMR implementation. Providers were generally satisfied with the EMR but desired additional training. Conclusions We successfully implemented a primary care EMR in three rural Kenyan health centers. Patient waiting time was dramatically lengthened while the nurses’ and the clerks’ patient care time decreased. Long-term use of EMRs in such settings will require changes in culture and workflow.

2019 ◽  
Vol 59 (2) ◽  
pp. 154-162
Author(s):  
Alexy Arauz-Boudreau ◽  
Alexa Riobueno-Naylor ◽  
Haregnesh Haile ◽  
Juliana M. Holcomb ◽  
Cara M. Lucke ◽  
...  

Using questionnaires, administrative claims, and chart review data, the current study explored the impact of using an electronic medical record system to administer, score, and store the Pediatric Symptom Checklist (PSC-17) during annual pediatric well-child visits. Within a sample of 1773 Medicaid-insured outpatients, the electronic system demonstrated that 90.5% of cases completed a PSC-17 screen electronically, billing codes indicating a screen was administered agreed with the existence of a questionnaire in the chart in 98.8% of cases, the classification of risk based on PSC-17 scores agreed with the classification of risk based on the Current Procedural Terminology code modifiers in 72.9% of cases, and 90.0% of clinicians’ progress notes mentioned PSC-17 score in treatment planning. Using an electronic approach to psychosocial screening in pediatrics facilitated the use of screening information gathered during the clinical visit and allowed for enhanced tracking of outcomes and quality monitoring.


2019 ◽  
Vol 15 (6) ◽  

BACKGROUND: Geographic cohorting (GCh) localizes hospitalists to a unit. Our objective was to compare the GCh and non-GCh workday. METHODS: In an academic, Midwestern hospital we observed hospitalists in GCh and non-GCh teams. Time in patient rooms was considered direct care; other locations were considered ‘indirect’ care. Geotracking identified time spent in each location and was obtained for 17 hospitalists. It was supplemented by in-person observation of four GCh and four non-GCh hospitalists for a workday each. Multilevel modeling was used to analyze associations between direct and indirect care time and team and workday characteristics. RESULTS: Geotracking yielded 10,522 direct care episodes. GCh was associated with longer durations of patient visits while increasing patient loads were associated with shorter visits. GCh, increasing patient loads, and increasing numbers of units visited were associated with increased indirect care time. In-person observations yielded 3,032 minutes of data. GCh hospitalists were observed spending 56% of the day in computer interactions vs non-GCh hospitalists (39%; P < .005). The percentage of time spent multitasking was 18% for GCh and 14% for non-GCh hospitalists (P > .05). Interruptions were pervasive, but the highest interruption rate of once every eight minutes in the afternoon was noted in the GCh group. CONCLUSION: GCh may have the potential to increase patient–hospitalist interactions but these gains may be attenuated if patient loads and the structure of cohorting are suboptimal. The hospitalist workday is cognitively intense. The interruptions noted may increase the time taken for time-intensive tasks like electronic medical record interactions.


Author(s):  
Karen A. Wagner ◽  
Frances Wickham Lee ◽  
Andrea W. White

The majority of users of an electronic medical record (EMR) at a family medicine clinic located in a small city in the western United States are currently quite dissatisfied with the system. The practice experienced a disastrous implementation of the EMR in 1994 and has not recovered. Although the level of dissatisfaction varies among the practice employees, several influential physicians are pushing to pull the plug and start over with a brand new system. The authors of this case studied this practice during a more comprehensive qualitative study of the impact of an EMR system on primary care. The practices negative experience was particularly noteworthy, because the other four practices in the larger study were satisfied with the EMR system. As with most system failures, there are multiple organizational and other factors that have contributed to the frustrations and dissatisfactions with the use of EMR within this practice.


PEDIATRICS ◽  
2008 ◽  
Vol 123 (Supplement 2) ◽  
pp. S100-S107 ◽  
Author(s):  
Karyl Thomas Rattay ◽  
Meena Ramakrishnan ◽  
Aguida Atkinson ◽  
Megan Gilson ◽  
Vonna Drayton

Author(s):  
Karen A. Wager ◽  
Frances Wickham Lee ◽  
Andrea W. White

The majority of users of an Electronic Medical Record (EMR) at a family medicine clinic located in a small city in the western United States are currently quite dissatisfied with the system. The practice experienced a disastrous implementation of the EMR in 1994 and has not recovered. Although the level of dissatisfaction varies among the practice employees, several influential physicians are pushing to “pull the plug” and start over with a brand new system. The authors of this case studied this practice during a more comprehensive qualitative study of the impact of an EMR system on primary care. The practice’s negative experience was particularly noteworthy, because the other four practices in the larger study were satisfied with the EMR system. As with most system failures, there are multiple organizational and other factors that have contributed to the frustrations and dissatisfactions with the use of EMR within this practice.


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