Topic 2 Wk 2

[Wirichada Pan-ngum]

What the good and bad of using EMR instead of the traditional paper based medical records in your setting? (10 Marks)

—–Due date 17 Feb 2020 ——

[w.thanachol]

EMR implementation in the hospital could be beneficial in several aspects while there are some limitations after digital transformation. After using EMR, health expenditure could be claimed from universal health insurance and the other two major insurances accurately and timely compared to the paper-based system. Registration procedure and space for collecting the registration card is reduced. Error from mismatching both patient identification and the test result are decreased. Moreover, EMR could early alert to inappropriate treatment such as drug allergy or fatal drug interaction prescribing. However, EMR could reduce the interaction between clinician and patients. Data confidentiality, integrity and availability are not well concerned in the current EMR system which makes data loss or open to unauthorized users. To conclude, EMR is useful in several ways yet it is needed to be improved to minimizing the limitations.

[tullaya.sita]

EMR helps hospital personnel in many ways. In the back office, the billing department can easily gather information on patient’s care services including physician and nursing charge, medication and treatment and, the procedure charge as it goes online not on the paper. It is a very efficient and safe time to bill the patient just once when they check out. Patients have no need to pay at every point that they receive treatment.
For the pharmacy. The EMR can decrease the medical error example for, drug interactions, dosing and translation errors due to a difficult-to-read prescription from doctor.
For the laboratory, the results from the measuring machine can go directly to the electronic laboratory report system without human input, this can reduce the human error on the laboratory results. Furthermore, the electronic laboratory reports allow clinicians can easily review the previous lab results of each patient.
For x-ray results, the PACs system can reduce the use of x-ray film which also reduces the waiting time for the results. Physician can view the image in the computer continuously, no need to spend a lot of time finding the picture of their interest in the batches of x-ray film.
For Physicians and nurses, they can review the patient’s histories easily. Also, physicians can order the treatment and pass it online directly to the pharmacy without the nurse’s copy or people for sending the doctor order sheet to the pharmacy.
However, the current EMR system is not pretty much user-friendly. As we all need to key the data for input to the system. The more work on the input into the systems, the less time we contact or interact with our patients. I think in the future, there will be some technologies to help hospital personnel for shortening the time to interact with the computer and improve our customer experience.

[Wirichada Pan-ngum]

Many practical points have been raised. Well done.

[Ameen]

I work for an insurance claim department in an insurance company which is a non-healthcare facility but using a system which has the same purpose as EMR.

***The good things about using such system are;***
1. The required data and information are a predefined set. Our agent does not have to figure out what kind of data to collect in order to analyze on basic of good practices.
2. Due to the (1), it helps saving time collecting data for every single case so each agent can have more productivity.
3. Due to (1), missing of data is less happens, the system is configured for any required data field. So the agent is always forced to enter all required data.
4. Data collecting can be more objectives, less of personal opinions. Standards of practices can be ensured, controlled and monitored.
5. Management of data and documents is more efficient. Space to keep documents is almost replaced with more workstation. As a private organization, renting of office place take most part of fix budget. Saving of workspace is an immediate benefit.
6. Analyzing collected data is always available as a data analysing system can access collected data anytime.
7. Information from the EMR is easily exchanged between departments.

***For the bad (challenge) things are; ***
1. Collecting data is repetitive and undermine work-life aesthetic. Sometimes, it feels like being only a data entry machine. Burning out happens when the agent has to work for the same role for years. By the way, job rotation has been in place to resolve this situation.
2. When incoming data is not aligned with the predefined set, it is needed to set up a new data field by the system administrator. However, this can be resolved by giving more role of administrator to the leader of each section of the department.
3. Data privacy and protection requires more technical understanding and skills, it is a must to hire a data/IT officer. However, training of basic understanding of data protection which used to be optional has already become a requirement after DGPR has been applied.
4. Using such a system need a digital transformation plan. The plan and implementation of needs budget and employee engagement. Cost-effective must be assessed well.

[Pyae Phyo Aung]

Good things using EMR in our setting
Data entry field level:
• High workload for both paper-based and electronic in short term will fall away when OpenMRS is up and running completely
• Assists day-to-day operation of patient consultation visit effectively
• Provides alerts and validations in order to obtain correct data
Clinician/ Pharmacist/ Laboratorial level
• Effective and improved case-based management for clinical assessment
• Quick overview for follow up visit management
• Analyze patient whole history
• View patient dashboard and chart module for each individual case
• Patient appointment list with ART drugs
• Daily dispense records
• Easy access in viewing lab requests and results
Program management level
• Monthly and ad hoc reports
• Drug treatment regimen assessment
• Monthly drug stock consumption
• Trends of national treatment on ART
• Monitoring and evaluation of the program • HIV-TB collaboration

Bad things
-People generally have a difficult time with accepting change, especially within the work environment.
-When implementing a new EHR system, anticipate a reduction in staff productivity, number of patients seen, and workflow efficiency and communicate this to your practice staff. Additionally, administration should prepare for potential overtime pay and the need for additional support.
-Migrating existing data to a new EHR is time-consuming and tedious. Additionally, it contains private and sensitive information that needs to be migrated accurately to ensure continued patient care. Records will need to be prioritized to determine how far back data should be migrated

[chanapong]

In my setting as a community hospital, I have seen the whole process of transitioning traditional paper-based medical records to EMR since 2019. During the transition period, It is more difficult to use EMR in low-experienced computer users due to a lack of EMR training workshops. Thus, it increases working time and services time until they are familiar with EMR. After EMR implementation for one month, health care officers can use it more efficiently. The benefits of EMR implementation were shown to us at this period.

1. Reducing workload for retrieving paper-based medical records including lab, EKG, and films. We can use the EMR to review patients’ medical records anytime we want. The staff can use ID card insertion to retrieve the medical record and make a hospital visit instead of searching a paper-based medical record one by one. In addition, it reduces the area for storing paper-based medical records and the cost of papers.
2. Reducing error in the identification process and treatment process. EMR can reduce the identification process by using the ID numbers in case of patients having the same name. The alerts for drug allergy, drug dosing, and ADR can help physicians work smoothly and flawlessly. Furthermore, replacing handwriting medical records to EMR reduces human errors from handwriting translation.
3. EMR system has more information and can monitor on each hospital process. Hence, we can use information obtained by EMR to improve hospital services.

In contrast, EMR has many disadvantages as described below.
1. Increasing the HCP burden to input more information in EMR. HCPs have to pay more attention to record patient information. Reducing the doctor and patient relationship is one of the effects of this problem.
2.Alert fatigue problem. Due to many alerts in EMR, some HCPs don’t pay their attention to them.
3. The EMR system is more expensive and difficult maintenance. We have to invest more funds for many infrastructures including electric generators and servers to support the EMR system. We also have to recruit IT officers for maintaining this system.

[Chalermphon]

My setting is INJURY SURVEILLANCE SYSTEM (IS)
The bad of using EMR instead of the traditional paper based medical records.
1. The beginning of IS, the officer (nurses) don’t accept the IS system because of the IS system Increase workload for officer worked together with EMR and paper based.
2. Increase time of the officers tried to understand the record form.
3. The beginning Staff always record mistakes.
4. Increase IT staff helped with the system and fixed the errors.
5. Increase resource for maintenance system of software hardware and protection.
The good of using EMR instead of the traditional paper based medical records.
1. Decrease time for search patient, edit record, duplicate record and summary data.
2. Decrease human error in record process.
3. Decrease time for special record by matching learning.
4. Reduce patient recorded duplicate in the same names or patient other information.
5. Data exchanged between other EMR systems.
6. Follow the situation of record for planning management.
7. EMR systems quickly supported direct or decision making.

[THONGCHAI]

In my think the good of use EMR instead of the traditional paper based medical records
– Decrease time to find EMR of patient
– Decrease time to report health information activity
– Decrease error to identify person to care
– Easy to shareing health information and EMR exchange
– Easy to research in health information system

and bad of using EMR instead of the traditional paper based medical records
– Increate Workload for health working
– Decrease time to relation between health care person and patient
– Not easy to work with computer
– Use a long time to understand application of EMR
– Disruption EMR working when computer error
– Have to training for using EMR instead of the traditional paper based

[Nakarin]

Advantage of using EMR instead of traditional paper-based medical records
– Patient safety – The healthcare provider can spend more time with EMR for making the decision for the patient’s treatment instead of a little bit of time during the patient visit.
– Effectiveness and efficiency – Using EMR can help the healthcare provider to make the decision while they can see every information of the patient just in one page or one time that they key-in the Hospital Number. When every important information can integrate together, the treatment will be more effective and efficient.

The disadvantage of using EMR instead of traditional paper-based medical records
– Increased risk of data breaches
– Using EMR can cause the patient’s uncomfortable
– EMR is not much user-friendly

[Penpitcha Thawong]

Change is one of the most difficult things for humans. At the beginning of using EMR, we think about financial issues: installing hardware and software, converting paper charts to electronic ones, and training the users, for example. There was a loss of productivity because of changes in workflow, and there also had privacy and security concerns because the information would be shared between many other systems. However, there are a lot of benefits, for example, higher-quality documentation, quick patient transfer between departments, easier to improve results management, no more handwriting problem, reduce time-consuming, and reduce human error.

[imktd8]

For using EMR instead of the traditional paper-based medical records, there are both Pros and Cons of using as below:
1) Costs
1.1 EMR
– High-cost system implementation.
– Time-less operation and manage data.
1.2 Paper-Based Medical Records
– Require more personnel to manage and maintain paper files.
– Spend time in operation and manage data.

2) Storage
2.1 EMR
– Can be stored in a private and secure cloud, allowing the use of fewer resources and providing easier access.
2.2 Paper-Based Medical Records
– Need space to store the document in a long-term period, ex. large warehouse, large room ete.

3) Security
3.1 EMR
– There are backup data storage daily or monthly and can setup security levels for unauthorized users.
– Risk in authorization, the security of an internal electronic storage system (Incase of pool security setting)
3.2 Paper-Based Medical Records
– Risk in data loss by human error, or damage as a result of a natural disaster such as a fire or flood. (many facilities keep just one copy of a paper record)

4. Readability and Accuracy
4.1 EMR
– Often difficult to read and understand. (mostly due to the physician’s illegible penmanship)
– Often written with standardized typeface and terminology.
4.2 Paper-Based Medical Records
– Often have insufficient space for healthcare professionals to write all necessary information.

5. Access
5.1 EMR
– Allow healthcare professionals to access the information they need almost instantly.
– Ease of use, fast access, and patients are treated in a more timely manner.
5.2 Paper-Based Medical Records
– Take time to use, most of them are stored in the warehouse and store that far from the clinical room.
– Spend time to find data and may not on-time in usage.

[Pacharapol Withayasakpunt]

Apparently, better EMR does require User Experience analysis, and it is not always intuitive, yet does not provide much useful data; that is, futility and burdensome.

So, I conclude that EMR vs paper-based have the following

– Advantages
– Querying through the data
– Easy to read

– Disadvantages
– Not always intuitive
– Cost of installation and maintenance (by IT team)
– Required some digital literacy

– Opportunities
– Can be better if the developers are innovative, and incorporate powerful technologies

After all, it is good to use technology, but moving fast can break things, and make it hard to maintain. This is always true in software world.

[Author]

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