IMPACT OF ELECTRONIC HEALTH RECORDS IN A HOSPITAL SET UP IN KENYA
by Judy A. Ouma
Introduction
An electronic health record (EHR) (also electronic patient record (EPR) or computerized
patient record) is an evolving concept defined as a systematic collection of electronic health
information about individual patients or populations. It is a record in digital format that is
capable of being shared across different health care settings, by being embedded in networkconnected enterprise-wide information systems. Such records may include a whole range of
data in comprehensive or summary form, including demographics, medical history,
medication and allergies, immunization status, laboratory test results, radiology images, vital
signs, personal stats like age and weight, and billing information.
Its purpose can be understood as a complete record of patient encounters that allows the
automation and streamlining of the workflow in health care settings and increases safety
through evidence-based decision support, quality management, and outcomes reporting.1
The EHR, allows physicians and staff members to document interactions with patients, view
medical histories and insurance information, make referrals, order laboratory tests and view
test results, send electronic prescription requests to pharmacies (reducing the risk that hardto-read handwriting will lead to medical errors) and flag potentially harmful drug interactions
It also provides physicians with "decision support" tools, such as clinical guidelines and
checks for drug interactions; and generates printed post-visit summaries for patients, among
other benefits.2
Statement of the problem
Most public hospitals in Kenya maintain manual health records. Data is entered manually and
bound to human error. There are cases of files being misplaced or lost altogether. Some
patients may not remember their patient numbers and therefore tracing their files is an uphill
task. There are also therefore cases of multiple entries of case files for patients when files
cannot be found. Tracing files is time consuming and leads to loses in working man hours.
Electronic systems engage health care workers with new methods and thought on medical
practices and care giving.
Shortage of staff is also a major problem in Kenya. The available staffs have little time to
research since they work throughout. Whereas cases may look new to staff, it could be
possible that it is not in other parts of the world and solutions may be available on the web. In
some hospitals the nurses are the billing clerks and therefore have to balance between billing
and offering nursing services. Generally care givers become more of administrative staff and
offer less in health provision.
1
Justification of the problem
In Kenya, with the funding for the health sector keeps dwindling, as a result, hospitals have
to consider efficiency and effectiveness if they are to keep afloat. They may need to consider
measures that assist health workers come up with appropriate methods for health care
delivery.
Upon arrival at the hospital the first point of contact is the records section where files are
kept. There time taken here can vary depending on the information given by the client and
the physical position of the file. In the event that it is lost more waiting time is required. A
patient has to move back and forth different departments and physically wait for their results.
Therefore whereas nurses and doctors greatly benefit from of EHR, patients are the greatest
beneficiaries.
Literature Review
The electronic health record (EHR) provides the opportunity for healthcare organizations to
improve quality of care and patient safety. “The greatest challenge in the new world of
integrated healthcare delivery is to provide comprehensive, reliable, relevant, accessible, and
timely patient information to each member of the healthcare team, whether in primary or
secondary care and whether a doctor, nurse, allied health professional, or patient/consumer”
(Schloeffel et al. 2).3
There are multiple advantages in using EHRs. Electronic health records (EHRs) have emerged
as a major topic in health care. Several studies have been done on the impact of EHR have
added weight to both sides of the debate. There are indeed advantages with the use of EHRs.
These include improve quality of care. The implementation of electronic health records (EHR)
can help lessen patient sufferance due to medical errors and the inability of analysts to assess
quality. Information Technology is being used today to automate day-to-day processes, thus
helping to reduce administration costs which then in turn can free up time and money for
patient care.
EHR systems can help reduce medical errors by providing healthcare workers with decision
support. Fast access to medical literature and current best practices in medicine are
hypothesized to enable proliferation of ongoing improvements in healthcare
efficacy.4 Improved usage of EHR is achieved if the presentation on screen or on paper is not
just longitudinal, but hierarchically ordered and layered. During compilation while
hospitalisation or ambulant serving of the patient, easing to get access on details is improved
with browser capabilities applied to screen presentations also cross referring to the respective
coding concepts ICD, DRG and medical procedures information.
EHRs also promote evidence-based medicine. They provide access to unprecedented amounts
of clinical data for research that can accelerate the level of knowledge of effective medical
practices. Realistically, these benefits may only be realized if the EHR systems are
interoperable and wide spread (for example, national or regional level) so that various systems
2
can easily share information. Also, to avoid failures that can cause injury to the patient and
violations to privacy, the best practices in software engineering and medical informatics must
be deployed.5
EHR systems have the advantages of being able to connect to many electronic medical record
systems. In the current global medical environment, patients are shopping for their
procedures. Many international patients travel to US cities with academic research centers for
specialty treatment or to participate in Clinical Trials. Coordinating these appointments via
paper records is a time-consuming procedure.
A study was done by Gill J M et al on the ‘Impact of EHR-based clinical decision support on
adherence to guidelines for patients on NSAIDs: a randomized controlled trial.’6 The study
felt that electronic health records (EHRs) with clinical decision support hold promise for
improving quality of care, but their impact on management of chronic conditions has been
mixed. It examined the impact of EHR-based clinical decision support on adherence to
guidelines for reducing gastrointestinal complications in primary care patients on nonsteroidal
anti-inflammatory drugs (NSAIDs). It concluded that only a small impact of EHR-based
clinical decision support for high-risk patients on NSAIDs in primary care offices and added
to the growing literature about the complexity of EHR-based clinical decision support for
improving quality of care.
A study was done to evaluate the interest taken by the health care providers in the electronic
medical file and its use within the quality improvement process by Boyer L et al 7. Sixtyseven percent of staff interviewed had a favorable opinion of the electronic medical file.
Physicians had more frequent favorable opinions than nurses who considered that electronic
medical files cannot capture real nursing activity. Health care providers considered that
electronic medical file could be associated with improved quality of care, but two points
should be taken into account: the increased documentation time (slow system response,
multiple screens, the lack of computer knowledge, the absence of bedside documentation
technology...) and dysfunctions in the information processing system. This could have an
impact on documentation completeness, and quality and could also lead to a reduction of time
devoted to care.
As much as there are many benefits of EHRs there are also issues that may that are still
controversial. These include the costs of installation and maintenance. The steep price of EHR
and provider uncertainty regarding the value they will derive from adoption in the form of
return on investment has a significant influence on EHR adoption.8 In addition, doctors do
not want to spend the time to learn a new system. Some doctors believe that adopting a system
with EHRs could reduce clinical productivity
Methodology
The Ministry of Medical Services has begun the process of computerizing high volume
hospitals. These hospitals will be evaluated to see the impact of introducing EHRs. Data will
be
collected
from
these
hospitals
and
evaluated.
3
Results
The policy on computerizing hospitals has borne much fruit. This is evidenced by availability
of data that can be used for policy planning. Reporting has improved in matters of time. There
are rarely cases of lost files and the time taken to locate a file is much shorter now. Patient
waiting time, which is the amount spent in the hospital is now reduced.
The uptake by clinicians is rather slow since they have not attended many training sessions.
Time to learn the system is also limited due to the current workload. Revenue generation has
also improved.
This proves that there is indeed an impact on the implementation of EHRs and should be used
in all public hospitals
4
REFERENCES
1. http://en.wikipedia.org/wiki/Electronic_health_record
2. http://www.pamf.org/ehr/benefits/
3. http://www.aameda.org/MemberServices/Exec/Articles/spg04/Gurley%20article.pdf
4. Arizona Republic: “Electronic Health Records: About $500 Million at stake in digital move.”
Ken Alltucker. March 20, 2011Sfgs
5. Hoffman S, Podgurski, A (Fall 2008). "Finding a Cure; The Case for Regulation and
Oversight of Electronic Health Record Systems" (PDF). Harvard Journal of Law &
Technology 22 (1): 10
6. http://www.ncbi.nlm.nih.gov/pubmed/21242557
7. http://www.ncbi.nlm.nih.gov/pubmed/19853719
8. RWIF,GWUMC, and IHP Staff: "Health Information Technology in the United States: The
Information Base for Progress", Robert Wood Johnson Foundation, George Washington
University Medical Center, and Institute for Health Policy, 200
5