Implementation challenges and Research Gaps of Electronic Medical Records (EMR) in Public Sector Hospitals of Sri Lanka

IntroductionGlobally, electronic medical records are central to the infrastructure of modern healthcare systems. Yet the vast majority of electronic medical records have been designed for resource-rich environments and are not feasible in settings of poverty. Here we describe the design and implementation of an electronic medical record at a public sector district hospital in rural Nepal, and its subsequent expansion to an additional public sector facility.DevelopmentThe electronic medical record was designed to solve for the following elements of public sector healthcare delivery: 1) integration of the systems across inpatient, surgical, outpatient, emergency, laboratory, radiology, and pharmacy sites of care; 2) effective data extraction for impact evaluation and government regulation; 3) optimization for longitudinal care provision and patient tracking; and 4) effectiveness for quality improvement initiatives.ApplicationFor these purposes, we adapted Bahmni, a product built with open-source components for patient tracking, clinical protocols, pharmacy, laboratory, imaging, financial management, and supply logistics. In close partnership with government officials, we deployed the system in February of 2015, added on additional functionality, and iteratively improved the system over the following year. This experience enabled us then to deploy the system at an additional district-level hospital in a different part of the country in under four weeks. We discuss the implementation challenges and the strategies we pursued to build an electronic medical record for the public sector in rural Nepal.DiscussionOver the course of 18 months, we were able to develop, deploy and iterate upon the electronic medical record, and then deploy the refined product at an additional facility within only four weeks. Our experience suggests the feasibility of an integrated electronic medical record for public sector care delivery even in settings of rural poverty.

Download Full-text

A national standards-based assessment on functionality of electronic medical records systems used in Kenyan public-Sector health facilities

International Journal of Medical Informatics ◽

10.1016/j.ijmedinf.2016.09.013 ◽

2017 ◽

Vol 97 ◽

pp. 68-75 ◽

Cited By ~ 9

Author(s):

Samuel Kang’a ◽

Nancy Puttkammer ◽

Steven Wanyee ◽

Davies Kimanga ◽

Jason Madrano ◽

...

Keyword(s):

Public Sector ◽

Electronic Medical Records ◽

Medical Records ◽

Health Facilities ◽

National Standards ◽

Medical Records Systems ◽

Public Sector Health

Download Full-text

Factors influencing Adoption of Electronic Medical Records in Government Hospitals of Sri Lanka

International Journal of Scientific Research in Computer Science Engineering and Information Technology ◽

10.32628/cseit206624 ◽

2020 ◽

pp. 190-199

Author(s):

Maheesa Dayananda

Keyword(s):

Developing Countries ◽

Sri Lanka ◽

Human Factors ◽

Electronic Medical Records ◽

Medical Records ◽

Digital Health ◽

Health Sector ◽

Organizational Factors ◽

Primary Data ◽

Government Hospitals

Electronic medical records (EMR) is a popular topic in the literature with the increasing use of EMR in both developed and developing countries. It supports to achieve health sector goals including but not limited to; improved quality, efficiency, cost reduction and patients’ safety and contributes to the sustainable development goal “ensure healthy lives and wellbeing for all at all ages”. Developing countries like Sri Lanka have a critical requirement of having innovative solutions to improve health outcomes while controlling the cost. EMR identified as a better solution to fulfil this requirement. However, it is questionable whether the rate of adoption is at a satisfactory level compared to the importance and benefits of the EMR. This study aimed at identifying critical success and failure factors in adopting EMR in Sri Lanka and propose strategies for successful adoption. Both primary and secondary data were used for the study. The study focused on experience of forty Government hospitals where the EMR systems established under the Digital Health Project, Sri Lanka. Primary data were collected from the health professionals and the regional project officers of Information and Communication Technology Agency of Sri Lanka who managed and coordinated the EMR implementation process in the hospitals. Focus group discussions (FGD), key informant interviews (KII) were mainly used as data collection tools. Further, the research papers published in peer-reviewed journals were reviewed. During the study, twenty-six factors that influence the success and failure of EMR adoption were identified. These factors were categorized and analyzed under six themes – i.e., human factors, technical factors, organizational factors, financial factors, legal factors and change management factors. The most influential category of factors was human factors. Even though the EMR implementation involves applying technology in the health sector, ‘people’ factor should not be forgotten. Ideally, the future EMR implementations should be based on the lessons learnt and best practices of the previous projects in order to achieve successful adoption and to avoid waste of resources.

Download Full-text

Person-centred care in a digital hospital: observations and perspectives from a specialist rehabilitation setting

Australian Health Review ◽

10.1071/ah17156 ◽

2018 ◽

Vol 42 (5) ◽

pp. 529 ◽

Cited By ~ 1

Author(s):

Letitia Burridge ◽

Michele Foster ◽

Rachel Jones ◽

Timothy Geraghty ◽

Sridhar Atresh

Keyword(s):

Electronic Medical Records ◽

Medical Records ◽

Task Complexity ◽

Spinal Injury ◽

Injury Rehabilitation ◽

Implementation Challenges ◽

Professional Discretion ◽

Cord Injury ◽

Specialist Rehabilitation ◽

The Impact

Objective This study investigated use of electronic medical records (eMRs) in a spinal cord injury rehabilitation unit and the implications for person-centred care. Methods This exploratory mixed-methods study conducted 17.5 hours of observations of practitioner–patient encounters, 50 patient-experience surveys and 10 focus groups with 53 practitioners. Descriptive statistics and qualitative analysis were integrated into key themes. Results Practitioners in this specialised setting were reconciling the emergent challenges of eMR in practice with the advantages of improved accessibility and documentation legibility. eMR increased task complexity and information retrieval, particularly for nurses. Some documentation was an uneasy fit with the specialised setting, disrupting informal communications and aspects of person-centred care. Conclusions Technological change closely aligned with frontline practice brought expected and unexpected challenges that may resolve over time. Practitioners’ persistence and adaptability demonstrated their commitment to person-centred care in the digital environment. The impact of this less visible work of professional discretion seemed to vary, primarily by discipline-specific roles, with nurses experiencing the greatest pressure. What is known about this topic? Integrated electronic medical records (eMRs) bring benefits but challenge person-centred care. What does this paper add? These first insights regarding frontline implementation of eMR in spinal injury rehabilitation suggest nursing challenges when seeking to fit specialised work into the generic eMR. However, most patients reported receiving person-centred care. What are the implications for practitioners? Commitment to person-centred care appears to strengthen practitioners’ perseverance with the eMR implementation challenges.

Download Full-text