THE WALL: Implementation of Electronic Medical Record

For this week we’ve been tasked to highlight three barriers to EHR implementation that we believe to be the most important ones that might adversely affect your implementation. 

To “creatively” discuss my points, I’m going to use some pop reference from the recently concluded season of Game of Thrones.

A brief background of myself before proceeding, I am Roy Dahildahil, a BS Public Health graduate from UP Visayas. For the past two years I’ve been working in National Telehealth Center (NTHC) and traveled to different Rural Health Units and Hospitals in different municipalities in the Philippines. NTHC is the institution that pioneered Community Health Information System (CHITS) that has been implemented to 160+ RHUs all over the Philippines. And thus, in addition to the articles provided to us, majority of my points are based on the stories and concerns I received while doing the field work.

  1. Change in workflow; cause of delays. Waiting

The initial implementation of the EMR is faced with a lot of challenges and adjustments to the Physicians. Especially those who are not tech savvy, or not into computers. Although, generation of reports, and some point and click functions of the EMR makes the job faster, when the Physician is not very adept to computer i.e. slow typing skills, visually challenged, not friends with their mouse or track pad, the usual encounter with the patient could actually be more time consuming because of EMR. Some of the Physicians I met in the field are more accustomed to writing and actually prefers to write. Challenge now happens when they are now forced to use the keyboard instead of pen. Their writing speed is not always proportional to their typing speed. Thus longer queues in the clinic.

In addition, since EMR are housed usually in a computer (others in a tablet), technology sometimes fails them. Lag, errors, loading, and other technical difficulties are often encountered why they are at point of care. This error, regardless how faultless techs are, are unavoidable.

2. Implementation CostsFinancial

In every municipality I’ve been to and physicians I talked to, I’ve always been asked about the cost of the project. I only thought about the “cost of buying project”, thus I always think it’s free. But then, as I went to other municipalities and witnessed how the RHU squeeze their budget to purchase additional computers, routers, keyboards, laptops, etc. in order to implement the project; I realized there is more (cost) than just buying the project. Human resource, facilities, equipment, and maintenance costs should be considered. In one of the RHUs I’ve been to, because of this additional costs the physician opted not to adopt the system because it is not the priority of their budget. If the plan is to implement EMR all over the Philippines, the government should plan how to lessen and eliminate the costs of implementing the EMR.

3. Not all Physicians are tech savvy

Training and expertise

Somehow related to number 1, struggle of some physician to fully implement the EMR is the fact that they have to learn how to use the computer . This is I think the very minimum requirement. However, most implementers assumes that physicians have background or efficient in using their computers. Only a few or none actually go back and train the basics of using a simple computer. Understanding how to use the EMR in itself is challenging, how much more to doctors who don’t even understand how to use the computers. As DOH program manager, or implementer, before conducting the training I should conduct training needs analysis and ensure that all of the physician being trained to implement EMR knows and has the basic skill set in using a computer or gadget (depends on platform)

4. Leadership and political will

leadership 2

Lastly, big factor for the nurses and midwives I’ve been to in implementing the EMR is the leadership of the doctor. When the doctor himself doesn’t use or reinforces his staff to use the technology, the technology always fails. In the same way with the physicians, should EMR be strongly implemented, a higher governing body must be strong and firm enough (on the premise that 1-3 are addressed) to reinforce his constituents to use the technology. For sure, at certain time it will be part of their system and will get use to using. It still boils down in institutionalizing the implementation of the EMR. A big step that could be achieved with strong political will of the leader governing them.



Credits to the owner of the Game of Thrones memes. 


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