Electronic Medical Records

electronic checkup Records Essay Cynthia J unitarys Grand Canyon University HCA 450 November 11, 2012 electronic aesculapian Records Essay aesculapian examination embark keeping has permute in the last couple of decades. In the past long-sufferings pull out ins were kept in a file on authorship taking up excessive room. In the past, opus charts were the only path of keeping a longanimous roles checkup exam examination diagnoses documented. Some of these charts argon still employ today in healthc atomic play 18 facilities, however they ar lentoly being replaced with a lots advance method electronic aesculapian checkup geniuss (EMRs).This virtual entropy development center tail assembly divine service as a vehicle to promote and to disseminate standardized selective development definitions and lift bug out pr act uponises to suppliers, consumers, and opposites interest grouped in quality mitigatement efforts nation in everyy and internation on th e wholey (Var aboriginal, 2010). The electronic medical exam Records is an advance ready reck starrizes medical record establishment that delivers medical info for mendeleviums office and hospitals within a be of seconds go offering c be. This dust every last(predicate)ows the health cargon mental faculty and physicians to modified, store and retrieves endurings medical records.Electronic medical records be legible and organized. The Electronic Medical Record (EMR) has been around since the late 1960s, when Larry Weed introduced the creation of the Problem oriented Medical Record into medical practice (NASBHC, 2012). Weeds innovation introduces the concept of the Problem Oriented Medical Record into the medical practice, which verifies the diagnosis (NASBHC, 2012). However, it wasnt until 1972 when the Regenstreif Institute develop the first medical records administration. Although it was a big(p) invention, physicians didnt chancek to employment it right a instru ction.This unexampled system of rules would divine service physicians break perseverings contend. Although, $19 billion in stimulus funds adjudge been invested into the Electronic health record (EHRs) a nonher name for EMRs the Obama administration highly suggested that health give c atomic number 18 and hospitals facilities step to the fore to digitize uncomplaining info and start qualification give out engross of the advance engineering(Greenemeier, 2010). The health care industry has been slow to adapt to this new system. Although the EMR system is intended to make patients records more(prenominal)(prenominal) brotherly for the physicians and ply, still galore(postnominal) pass non implemented it yet.Given the pretermit of EMR sufferance through with(predicate)out the health care industry, slight than 10 percent of U. S. hospitals train adopted electronic medical records. Cost is the primary reason many founder resisted or are un for endureing to adop t the EMR system and famine on staff as advantageously. In a recent interview on November 9, Jessica in human resource at Vineville Internal Medicine, with Dr. bloody shame Bell Vaughn presiding as the physician all oer the practice. The practice has been using electronic medical records systems since the practice open in 2002. Dr.Vaughn thought patients and staff essential easy approach shot to their records when needed. Some of her other reasons are as tamp on Paper slight, Less storage No physician running around ( patient info avai laboratoryle at finger tips) Saves succession spent with patient Good for tracking in versionation Financial Good This system is weathervane establish and applys an E-Clinical program through a portal. This system likewise allows prescriptions to be sent to the local pharmacy as easy. Blood work results are withal put into the patients charts as well.Recently, the practice likewisek on new patients with account charts, because t heir physician retired. In this cause their most recent charts were converted over to EMRs. However those paper charts still exist in a down in the mouth storage area if further randomness is needed on the patient. though the practice implements the EMRs system from the very beginning, the physician and staff are very happy with the system. around patient information is put into the system via information processing system on the spot age the patient is telling the nurse or physician what is ailing them.Although there system is a web based system, it has ii backup systems in two different locations just in case the systems go down or power outage. The EMR system has had great quality invasion on the practice. The patients care has been advance by the system. It allows the physician to track and effectively treat the patient. In some cases if the patient is turn up at a nonher healthcare facility this system allows them to send information to multiply tribe for care, no matter where they are. Dr.Vaughns practice is already looking into the future to implement sending out text cognitive contented to patients to inform them of appointments. Patients contrive portal to their care any sequence. EMR adoption is slow to be implemented into some practices. Although there is some disapproval of the electronic medical records today, it is merely a digitized version of paper chart. This system will humiliate medical errors and help put information in front of look forers This new form of technology is here to stay and the so whizr healthcare facilities start using it the more efficient results they will happen.References Prathibha Var attain (2010). Medical Quality trouble, Sudbury, mammy J whizs and Bartlett Publishers. History of the Electronic Medical Record system (2012) Retrieved November 8, 2012 www. nasbhc. org forget Electronic Medical Records Improve Health Care? (2009) Retrieved November 8 2012 http//www. scientificameri fag end. com/ar ticle. cfm? id=electronic-health-recordsElectronic Medical RecordsEngineering Management field Project Electronic Medical Records A Case meditate to Improve Patient Safety at empurpled capital of Seychelles Teaching Hospital By Annie Bittaye Spring Semester, 2009 An EMGT Field Project handle submitted to the Engineering Management Program and the Faculty of the grad School of The University ofK. ansas in partial fulfillment of the requirements for the stratum of Masters of Science )= , , tomcat Bowlin Cotntnittee Member k Committee Member Date accepted _ _&-4_/,,,,,,1_-. -Q,,.. r5c-_ _ carry over of ContentsTable of Contents . 2 describe out of Figures 3 itemisation of Tables .. .. 3 Ac effledgments executive director Summary 5 1. 1. 1. 2. 3. 3. 1. 3. 2. 3. 3. 3. 4. 4. 4. 1. 4. 2. 5. 6. 7. Introduction 6 earth of Royal capital of Seychelles Teaching Hospital 7 writings Review 0 mental process and Methodology .. 17 Experimental De compact . 17 discern military op eration 18 Data Analysis 9 Limitations of the open field .. 19 Results 20 Reasons why EMR is not being employ at RVTH .. 23 Benefits and challenges of EMR. 24 Summary.. 0 Conclusion .. 30 Suggestions for Additional Work 32 References . 34 Glossary . 5 Appendix 36 2 describe of Figures Figure 1 Sources of funding, RVTH 2008 .. 22 Figure 2 Averages ofEMR functions in assure of relevance to work at RVTH 29 List of Tables Table 1 Number of patients seen at RVTH in 2008 .. 7 Table 2 List of Professionals, RVTH 2009 . 0 Table 3 computing device ownership and previous ready reckoner teach stock by the respondents at RVTH .. 28 Acknowledgments My journey towards my Masters degree was a long and fruitful one. The Engineering Management (EMGT) program has not just exposed me to much information and ideas just in any case undefended a way towards my career path. Thank you to my parents, Ebrima and Lucy who fork out ceaselessly been a source of great inspiration and strength t o me. They taught me the value ofeducation and their prayers has always been with me.Thanks to my brother, Baboucar who advance me to pursue my Masters degree and the never ending endure I receive from him. Special thanks to my six year old son, Ebrima for his catch that Im at school when Im not home to read him a bedtime story. I also necessitate to thank all my EMGT instructors in particular Professor Herb Tuttle, Dr tomcat Bowlin and Ray spear who worked with me recently, for the wonderful information and feedback they provided on this project. Thanks to Parveen Mozaffar for her thorough conduct and encouragement during the course of my studies.Thanks to the staff at Royal Victoria Teaching hospital for providing me with all the needed information for this project. Last but not least, my gratitude goes out to Dr Don Anthony Woods. It is because of his influence that brought me where I am today. He always had my best interest at heart and I want to thank him for that. May God bless you Executive Summary Most countries in Europe and the USA are increasingly using an electronic medical record (EMR) system to help improve healthcare quality. Unfortunately, The Gambia presidential term faces a series of health crises including but not limited to human immunodeficiency virusIAIDS, malaria, diabetes and tuberculosis.These diseases jeopardize the lives of thousands of people. Lack of understructure and trained, experienced staff are considered important barriers to scoring up treatment for these diseases. The contribution of this field proj ect outlines the benefits of an EMR system at Royal Victoria Teaching Hospital (RVTH) and how it will improve patient impregnablety. This is a descriptive tuition using interview questionnaires from officials at the Royal Victoria Teaching Hospital. The study also looks into other facilities in convertible growing countries with advanced systems, but not so advanced as to be at the level of state-of-the art facil ities in the U.S. Results from this study aims the immenseness of an EMR system at RVTH to help oneself effective and efficient info collection, selective information entry, information retrieval and report generation. As a catalyst for development, the execution of instrument of an EMR system at RVTH may make it one on the best hospitals in the West Afri gouge region. 5 1. Introduction According to Dick and Steen, Electronic Medical Record (EMR) is the compilation of patient medical information in a computer-based format that allows the collection, storage, retrieval, and communication of this information.An electronic medical record replicates a paper chart and contains both clinical information (diagnoses, allergies, drug resistance and treatments) and demographic information about a patient it provides a comprehensive medical picture and git be utilize by clinicians as a tool to determine appropriate treatment for patients. EMR is not only being welcomed by healthcare providers as a way to improve care economy but also serves as a catalyst and gold standard for development (porter, Kohane, & Goldman Reifsteck, Swanson, & Dallas).Unfortunately, Africa, a continent face with many challenges ranging from epidemics, civil wars, and disasters, neglects robust healthcare infrastructure in the form of computerized health care systems. For instance, Ghana has one the best health institutions in the region, Korle-Bu Teaching Hospital. This Hospital, for example, is currently the only institution in the West Afri back sub-region which performs surgery. Due to the quality of outcome, it now receives referrals from most parts of the continent namely the Gambia, Sierra Leone, Liberia, Togo Benin, Tanzania, Nigeria, Cameroon, Cote d Ivoire, and Ethiopia.Despite its exemplary performance, the hospital has no computerized information system which nates help improve care slant in the region. Therefore, the purpose of this study is to hit the books the pote ntial benefits of EMR and its ultimate contribution to improving healthcare delivery development in less developed countries like The Gambia. 6 1. 1. Background of Royal Victoria Teaching Hospital The Gambia is a small landed estate in West Africa, with a population of approximately 1. 5 million. RVTH has been in existence for over 100 years in The Gambias capital, Banjul.It utilize to be called Royal Victoria Hospital until in the late 1990s, when its name was changed to RVTH. The Gambian authorities adjudicated that it had to reduce its dependency on foreign doctors by establishing a medical school in the University of The Gambia (UTG). The UTG now uses RVTH to teach its clinical students. In recent years, The Gambia has been doing much on its own maiden to eat to improve the healthcare of the nation. There are 540 beds in the hospital and the two largishst Departments are Pediatrics and Maternity.The biggest killer disease in The Gambia is malaria, with young children and enceinte women being particularly vulnerable to this disease. Diabetes, high blood pressure, pneumonia and eye problems such(prenominal) as trachoma and cataracts are also major health problems. The following slacken provides an estimation of how many patients were seen at RVTH in the year 2008. Procedure inmate Admissions Children admitted to Pediatrics Patients treated in the Eye Center Out-Patient Appointments Out-Patients in the ER Number of Patients 25,281 9,352 986 over 184,365 24,334 Table 1 Number of patients seen at RVTH in 2008 7Unfortunately, RVTH does not withstand any EMR system in place to comfort patient recourse. As noted by participants, EMR software is not employ at RVTH because administration keeps complaining of money. It looks expensive to them and also they are more used to the paper folder. Currently, information is very fragmented and because does very little to help patient safety and consistency in care. other important issue here is that a large numb er of these patients are illiterates. To ensure they receive the appropriate treatment, they will have to let off to the physician current medications they are taking etceteraThis can be a very challenging and fatal to the patient sometimes. The typical paper medical record contains roles including information on demographics, admissions, discharge summaries, progress notes, protocols, laboratory results, radiology results, surgical and pathology reports, orders for, treatment and nursing notes. Most verify regarding treatment of a patient is written directly in the patients medical chart. On a given day a patient arrives at the hospital for care, sign in his name and waits anywhere from 30 minutes to six hours o get their records pulled depending on the day. Physicians, nurses, medical residents who need access the information in the medical record essential wait till its available. Typically, medical records are transported to the outpatient clinic where the patient would b e seen, and then returned to storage center to be filed again. It is obligatory for the medical record to follow the patient throughout their visit. If the patient was seen in one clinic where orders were written, it was necessary to physically transport the record when the patient move to the medicine room for treatment. The purpose of this field project is to examine the potential benefits of an EMR system and its ultimate contribution to improving patient safety at the Royal Victoria Teaching Hospital in The Gambia. 9 2. Literature Review The first generation of EMRs was extensions of medical billing systems in large US hospitals. Over the last four decades, they have been used as tools to organize and store medical data. EMRs are widely accepted as important tools to support high quality health care in the US, Europe and other developed countries.Evidence shows that using EMRs that include decision support systems improves quality of care and both reduce medical errors and unn ecessary medical investigations (Partners in Health), Experience with the use of EMRs in developing countries, if available, is much more limited than it is in the US and Europe. Now there is considerable interest in using medical information systems to support the treatment of HIV and TB in Africa, Latin America, and Asia. In most African countries, healthcare information systems have been driven mainly by the need to report aggregate statistics for regimen or funding agencies.Such data collection can be performed with simple paper forms at the clinic level, with all electronic data entry done centrally, but that approach tends to be difficult and time consuming and may provide little or no feedback to the staff collecting data. Individual patient data that are collected and ready to hand(predicate) at the point of care can support clinical roll in the hayment. Clinicians can slowly access previous records, and simple tools can be embodied to warn of potential problems such as incompatible drugs.Physicians or nurses can check on the outcomes of individuals or groups of patients and perform research studies. Many of these functions will work well on paper or with simple spreadsheets for up to 100 patients but become very time-consuming and potentially perfidious with more than 1,000 records, and virtually impossible with 10,000 or more. 10 Experience with the use ofEMRs in developing countries is much more limited than it is in the US and Europe, but there is now considerable interest in using medical information systems to support the treatment of HIV and TB in Africa.Some examples of EMR use in Africa include The Regenstrief Institute in collaboration with Moi University in Kenya developed an EMR for general patient visits to clinics in western Kenya. This system was afterward modified to support the care of several thousand HIV patients. monkey-bread tree Health Partnership in Malawi has developed an EMR system using innovative, low-power touch-scr een PCs for data entry and display. This system is now used to support the care of more than 7,000 HIV patients in the Lighthouse clinic in Lilongwe and has been chosen by the national HIV program for use throughout the country. emailprotected, an HIV medical information system developed for US patients, has now been deployed in Uganda and is intend for use in other African countries and in Latin America. (Partners In Health) A wide-ranging literature review of electronic medical record implementation over the past decade reveals that clinical, work flow, administrative, and r all the sameue enhancement benefits of the EMR exceed barriers and challenges. Among other key efforts, organizations essentialinessiness train and motivate drug users to navigate EMR systems, as well as develop a common structured language.Clinicians who used CPRs prove that electronic 11 access to clinical infonnation howevers time and provides a thorough and efficient way to manage patient informati on To pull out the full benefits of an EMR, organizations must redesign current workflows and practices to evolve into efficient providers of care. EMR systems are developed to meet the following goals improve quality of care, reduce organisational expense, and produce a data stream for electronic billing. (Dassenko and Slowinski).The EMR meets these goals through workflow automation, connectivity, and data mining. (Gaillour) The Computer-based Patient Record Institutes (CPRI) definition concurred with the other researchers, but added that the EMR provides protective covering of patient and provider clandestineity, has a defined vocabulary and standardized coding, produces documentation as a by-product of patient care, connects local and remote systems and provides electronic support for secondary users (payers, policymakers, researchers). Fromberg and Arnatayakul) Unfortunately, most EMR systems are unable to offer all of the components defined by the CPRI because the technology is too complex and too expensive, doctors wont use computers, and standards dont exist. (Gaillour) The advantages associated with implementing EMRs are well documented and are straightforward. The difficulty comes with placing a sawhorse figure to these advantages consequently, few organizations have published studies describing the actual apostrophizes and benefits accomplish from implementing EMRs. Bingham) The benefits associated with CPRs are organized into four categories clinical, workflow, administrative, and revenue enhancement. Renner, states that measuring all the benefits associated with EMRs is 12 virtually impossible, and that it is probably safe to select those that can make the superior monetary difference, and incorporate them into a financial model.Clinical benefits seen after implementing an EMR include better access to the chart, improved clinical decision making and disease management, compound documentation, simplified patient education, and increased free time to spend with patients, tended to(p) by improved perception of care and quality of work life. These benefits last result in better delivery ofpatient care and safety. Despite all of these benefits, EMRs are not a standard in todays healthcare systems. It is perspicuous that EMR technology is still a hot topic for discussion when shop through current healthcare technology and management journals.The following barriers have kept healthcare leading discussing EMR technology instead of adopting it cost, leadership, ROI, vendors keeping up with users needs, and deficits in the following categories public policy, standards, security, and a true definition. First of all, cost has kept organizations from implementing EMR systems. These cost can be organized into the following categories software, big(p)ware, infrastructure development and occupy, implementation, education, planning, and administration.Software costs include development or purchase, maintenance, and upgrades ov er time, eon hardware costs include purchase of workstations. (Mohr) Infrastructure development and maintenance costs include servers, interfaces, workstations, network cables, network maintenance, and help desk operations. Planning costs include development of an implementation plan, identifying measurable outcomes, and choosing meaningful metrics and goals, while implementation costs include training, overtime 13 ssociated with entering patient data, business disruption during transition, employee resistance to change, and lost productivity. Drazen, suggested that leadership was probably a more significant barrier than cost because, in the past, healthcare leaders have raised capital for essential business initiatives such as major building programs, acquiring a physician network, or scratch up a managed care organization. This amount of capital is on the equivalent scale as an EMR. Next, Drazen stated that a lack of government support is a major issue holding up EMR implementa tion.Unfortunately, the federal government does not contribute fmancially to EMR implementation projects. Without standards and structured data definitions, computer systems are not guaranteed to interface well with each other, and databases are not easily developed. Most individual departments within a healthcare system have already invested in computerized patient information systems however, these systems are isolated and do not communicate well with one another. Getting these systems to interface is one challenge facing EMRs. Data security continues to be an ongoing challenge.Bergman, found that politicians, consumer advocates, and the general public have voiced concerns about risks to the privacy and confidentiality of patient information. However, when compared with the security of the paper chart, the EMRs electronic audit trails and pass oral communication actually improves internal security. The EMR may be more secure for internal breeches of confidentiality, but must also be protected from external breeches such as hackers, who could potentially enter the EMR from an off-site location and download volumes of 4 confidential information. Firewalls and encryption software are methods used to protect patient data from these violators. Clinicians who use EMRs recognize two benefits First, electronic access to clinical information saves time. Second, electronic access provides a thorough and efficient way to manage patient information. With EMR systems, comprehensive information can be located and presented in a way that is relevant to the task at hand. Dassengko and Slowinski) The obstacles identified have thus far been insurmountable, but the considerable achievements identified in the benefits section of this discussion suggest that the advantages are well worth the effort. As Lenhart et al state, Success comes at the price of considerable effort, persistence and optimism, as well as dedicated leadership. (p. 114) some organizations that invested in e arly EMR systems are assay to show the qualitative benefits promised by vendors because an electronic version of current work processes is not cost effective. Sandrick) If the ROI were a function of the information tool itself, the financial benefits would be experienced universally. (ROI The White Paper. A Business Case for Electronic Medical Records) To get the most value out of an EMR, healthcare organizations must reengineer the following work processes to make full use of the system healthcare organizations must first train and motivate their users on how to navigate and conk the EMR tools. To optimally use the EMR, it must be implemented from registration through billing, thus allowing the organization to realize full potential benefits across the delivery system.These benefits include clear, concise, and comprehensive documentation, greater efficiency, care consistent with best practice guidelines and improved claims processing. 15 It is difficult to measure the economic value associated with less tangible benefits such as higher quality of care, patient service, provider and employee satisfaction, and competitive advantage. It is even more difficult to allocate necessary resources and level to institutional change when the paper chart is getting the job done, even if it is not in the most efficient style.However, Carlon, suggests that all providers should embmce the EMR to deliver safe medical care. The information in the EMR can reduce medical errors to nullify dangerous, sometimes lethal, mistakes. If organizations cant show that EMRs have a positive ROI, they may decide that the EMR is just another expense of running a business. The expense is to improve patient safety and reduce medical errors. This review of literature empha coats that the use of EMR systems contributes to the ultimate goal of delivering effective care while improving patient safety. 16 3.Procedure and Methodology The study is an exploratory study conducted in Banjul, The Ga mbia, to examine the potential benefits ofEMR and its contribution to improving patient safety. For the most part, this study is descriptive and categorized as a non-experimental qualitative study. Initial contacts were made with the top dog Medical Director, Development Officer and the Head of Medical Records at the RVTH to crave participants for the study. 3. 1. Experimental Design Survey approach was used to gather data from healthcare professionals who are considered potential users of EMR.Copies of the questionnaires were sent through e-mail to participants. A total of 50 surveys containing 15 questions were sent out and 30 of them were returned. The content of the survey designed was open-ended questions based on the following areas fellowship of EMR, benefits and challenges of EMR, transition from paper-based system to EMR, security issues associated with EMR use and assistance given to developing countries by developed nations to implement or use EMR. Other areas include, demographic details of respondents based on profession, length of practice, age and sex.The survey questions can be found in the Appendix. Participants were selected based on their level of healthcare training. The population set for the study was healthcare professionals from the RVTH, which includes physician consultants, surgeons, pharmacists, nurses, midwives, pathologists, radiologists, and laboratory technicians. Study participants were limited to these previously mentioned health professionals, since they would be the principle users of an EMRsystem. 17 RVTH has a total population of about 500 professionals and a sample size of 50 was chosen for the study.Since this was the first time such a study was being conducted in the country, there was limited knowledge of professionals on the subject as well as difficulty in getting volunteers to participate. 3. 2. Survey Procedure Survey questionnaires were converted into a PDF file and mailed electronically to all 50 participants o n February 2, 2009. Unfortunately, basketball team medical professionals who were initially contacted to participate in the study later declined to take part due to lack of understanding of the survey questions. As a result, different participants were contacted to replace the five individuals to make up the sample size.Since the researcher could not travel to Gambia to help oneself the survey, one of the administrative officers at the hospital was contacted and helped to distribute hard copies of the questionnaire to all participants. Participants were requested to fill out the attached survey and return it in a sealed envelope to this person or the chief administrator. aft(prenominal) three weeks, on February 23, 2009, a first reminder was mailed asking for their cooperation and the importance of returning the survey. A final reminder was sent out on March 9, 2009, to those who might have forgotten to return the survey. 8 3. 3. Data Analysis The 30 completed surveys were coded , sorted, and organized into themes. A spreadsheet was created in MS-Excel to enter all data for analysis. All responses were placed into themes and summarized. The survey responses and themes generated were used to determine result interpretation, recommendation, and future research direction. Despite initial difficulties to get volunteers to participate in the study, 30 out of the 50 surveys mailed were returned on March 16,2009, thus representing 60% response rate. 3. 4. Limitations of the studyDue to the difficulty of getting other hospitals in the area problematic, the study was limited to RVTH only_ The findings represent views ofthat hospital alone. However, the research would have been more interesting and challenging if more professionals from other hospitals were involved in the study. Secondly, due to cost of air travel between the get together States and Gambia, the researcher was not able to travel to Gambia to collect the necessary data for the study. The inability o f participants to respond to some important questions on the survey skewed the data.Finally, due to the six hour time difference between Kansas and Gambia, it was hard to reach the participants at during business hours. Lack of high speed net or sometimes no connection at all caused the check out in receiving all the responses on time. It was also really difficult to get people to cooperate because the survey was not on their list of priorities. 19 4. Results Based on the methodology, surveys were mailed to 50 participants at the RVTH in Banjul, The Gambia. thirty completed surveys were have which include 15 questions.The results from all participants are as follows The 30 respondents consisted of 17 males, 11 females and two people who did not indicate their gender. The age range of the group was 25-56. Table 2 presents the professional diffusion of participants. No Response represents people who did not include their profession. The five students, however, included final year medical and dentistry students, as well as nursing, and medical laboratory students. Professional experience ranged between 1 and 20 years.Profession Surgeon Pharmacist Physician Radiologist Midwife Nurse research laboratory Technician Student No Response Total Table 2 List of Professiona is, RVTH 2009 Number 3 2 3 2 5 6 2 5 2 30 20 To analyze this result, key words such as computerized, storage and retrieval, were used to determine respondents understanding of the concept of an EMR system. Subsequently, one-third of respondents (33. 3%) who included these three key words were marked as right. While nine people representing 20% who verbalize it is a mechanism for storing patient medical record on a computer were classified as partially right and approximately half(prenominal)(a) respondents (46. %) who just said the use of machine to keep patient medical data were classified as having an idea or understanding of the system. In addition, implementing and running a successful EMR system requires a number of key elements. Accordingly, 15 people identified technical elements such as (electricity, hardware, software, etc. ), 10 stated patient data, while four said tolerable trained personnel, and one person indicated the need for money to train staff on EMR. Also availability of adequate infrastructure such as experts to support and train care providers on EMR is very crucial when implementing EMR system.However, more than half respondents agreed that enough infrastructures are not available in Gambia to support EMR implementation. On the other hand, 10 people opined that infrastructures are available, while four said available infrastructures are only few. Despite unavailability of infrastructures, 16 respondents reported there are enough computer experts in Gambia to train healthcare providers to use EMR. Seven reported experts are not available six stated experts are available but too few to meet the demand and needed training requirement of the healthcar e sector.Lastly, one person indicated he has no idea of the subject. Responses concerning how much developed nations are assisting less developed countries like Gambia with Health Information Management (HIM) system infrastructure 21 implementation showed diverse opinions. Nine people said developed countries are helping, 15 responded no. However, six indicated that the help given from developed nations are not enough and sometimes electronic devices sent to less developed countries like the Gambia are inferior and lack quality.Still others think some form of assistance comes in to support the country on information management systems but not much is channeled towards the health sector. Lastly, seven people reported they have no idea if developed nations are helping and one person did not respond to this question at all. This pie chart below shows the sources of funding and the amounts received for the year 2008. Sources of Funding 2% Gambia Government Patient User Charges gratu ity Fund Internally Generated Fund Global Fund Severe Malaria in African Children FundFigure 1 Sources of funding, RVTH 2008 22 The majority of funds come from the Gambia Government in the fonn of subvention received monthly or quarterly in advance. However, about 70% of the amount goes towards payment of salaries and allowances to approximately 1,200 staff. Other donations received are in the fonn of drugs, equipment, supplies and services which made considerable contribution to the hospital. (RVTH) 4. 1. Reasons why EMR is not being used at RVTH Paper records are wide and can take up costly lieu.Filing, retrieval of files, and the re-filing of paper records are very labor-intensive methods with which to store patient infonnation. Plus if a record is checked out for one department, another department cannot access the chart. The impact of not having immediate access to key infonnation in emergency situations can be serious. Paper medical charts also cannot be effectively search ed and used to track, analyze, and/or chart voluminous clinical medical infonnation and processes. They cannot be easily copied or saved off-site.Also physicians orders and the corresponding results such as medications and labs can be issued and saved in a comprehensive EMR system. Our literature review and results have proven that paper records are costly, cumbersome, misinterpreted, easily misplaced and cannot be used for any meaningful decision analysis. Unfortunately, RVTH does not have any EMR system in place to improve patient safety. As noted-by participants, EMR software is not used at RVTH because administration keeps complaining of the lack of money. It looks expensive to them and also they are more used to the paper folder.Nevertheless, four key issues were identified by participants as the main reasons why RVTH does not have an EMR system in use. 23 Overall, 36% of respondents attributed the problem to lack of resources in monetary value of personnel and infrastructure, 29% blamed it on lack ofleadership initiative and priority. While 18% reported cost in terms of equipment and training personnel, 15%, however, stated lack ofEMR importance or apprisedness and forethought to change. Lastly, 2% respondents did not give any reason. 4. 2. Benefits and challenges of EMR There are both benefits and challenges to EMRs.Many argue that positive aspects of using an EMR system outweigh the challenges. Even though the investments in EMR systems are costly, most argue that over time this outset cost will result in greater savmgs. As well as cost saving, many agree that one advantage of EMR system is that they save space. Instead of keeping huge paper files on patients, all records are kept on computer files. Though someone must store these records in computers, this still represents a small percentage ofthe space infallible to store physical records. Along with saved space is reduction of paper used by hospitals.Although EMR systems do not render paper obs olete, but they certainly do reduce needed paper significantly. Another advantage of electronic medical records is the ability for all in a health care team to coordinate care in terms of monitoring and treating diseases. This helps avoid duplication of testing, prescribing medicines that in combination might be dangerous and the ability for anyone on the medical team to understand the approaches interpreted to a condition. A person with complex health issues may see several specialists, and can easily become confused by lapping or contrary advice.When specialists and primary care doctors use the same system for electronic medical records, then everyone on the team would be aware of all the other team members actions and recommendations. Electronic medical records may save time as well. Though faxing and email may assist one doctor to get information from another doctor or a laboratory, there is generally a wait time to receive this information. When a doctor has instant access to all of a patients information, including things like x-rays, lab tests, and information about prescriptions or allergies, he or she is ready to act right away, thus saving time.This may be particularly laboursaving in emergency situations where a patient cannot answer questions about medical memorial or allergies due to extreme illness or injury. Generally, doctors are often considered to have the worst handwriting, though this is just a generalization, indecipherable writing can lead to misinterpretations and mistakes. Typed notes and prescriptions are more legible and less likely to create misunderstandings. However, electronic medical records do not chemical formula out the occasional typo. One of the main disadvantages to EMR system is that start up costs is enormous.Not only must you buy equipment to record and store patient charts (much more expensive than paper and file cabinets), but efforts must be taken to convert all charts to electronic form. Patients may be in the t ransitional stage where old records havent yet been converted and doctors dont always know this. Further, training on EMR software adds additional expense in paying(a) people to take training, and in paying trainers to teach practitioners. In fact, one concern about the use of electronic medical records is that doctors may have a significant learning curve when these programs are first implemented.A scummy 25 typist may actually take a long time to input information. Doctors often have to be their own medical clerks especially during an office visit, and a doctor distracted by confusing technology may not be as alert to a patients symptoms or needs. There is no single electronic medical records source or system, so different hospitals and individual clinicians may not all be using the same program. This negates the possibility of instant information for all on the medical team, since one program may not communicate with another.Another concern is that electronic medical record syst ems might be hacked and exploited by others. Since one of the first considerations of medical treatment is confidentiality, it may remain a concern about how many people may have access to other medical records which they are not authorized to do so. debauch of private medical information could create problems for people who have conditions they respect to keep private. Despite these concerns, it appears many hospitals are now attempting to use EMR systems.It form unclear how long it will take for hospitals to transition completely from the traditional paper-based systems to a complete paperless environment. As shown from the survey results, it is clear that many participants believe that implementation ofEMR will tremendously improve upon patient in the country. For instance, as noted by one respondent, availability of patient past history in electronic format will enable health care workers have information about patients in seconds and with ease which will facilitate quick dia gnosis and treatment hence reducing the rate of mortality. 26There is always some level of fear and resistance to change, especially in the healthcare industry. A question concerning the level of acceptability from the traditional paper-based system to EMR system shows that such change will be met with some difficulties. More than half of respondents said the process would be challenging initially, but eventually care providers will accept the system because it will improve patient safety and work performance. Although the majority may still prefer the paper-based system, they will change when they see the importance or need for EMR stated a participant.Others also believe it would be a welcome idea. The adequate tax shelter of patient health record requires limitations at all levels, such as collection, use, access, and disclosure. Therefore, development of privacy, confidentiality, and security principles is necessary to protect patients interests against inappropriate access to their health data. Unfortunately, 14 respondents (47%) did not respond to this important question regarding measures necessary to keep up patients privacy, security, and confidentiality at RVTH.However, 16 people representing (53%), did state that all health records must be securely protected by use of password, data encryption, and access restrictions to users. It is obvious from the survey results that effective implementation and utilization ofEMR can improve patient safety in developing countries. Considering training as one of the key elements to EMR success, a question was asked to determine length of time required to train care providers in Gambia on EMR.Almost 50% of respondents indicated it might take 6-18 months depending on practitioners ability to understand the concepts ofEMR as well as the user friendliness of the software. Others believe for 27 current medical students who are already computer literate may take about two weeks, but the older practitioners will take l onger time (approximately over a year). Table 3, below shows the number of respondents that own a computer or has had some form of computer training in the past. Computer Training Profession Own a Computer 1 1 1 0 1 2 1 2 I Yes 1 1 1 0 2 3 1 7 16