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Being a Myanmar national, I can relate with first hand experiences to the challenges shared in the paper. At the same time I also saw a massive potential to improve the systems.
The following are the advantage and disadvantage of using EMR instead of the traditional paper based medical records in the projects that I’ve worked on in Myanmar.
Advantages:
Improved Data Quality: EMRs can ensure accurate and complete data capture by automatically checking for inconsistencies and errors. We are now able to use Google Studio to visualize the data in near real-time.
Better Data Security: EMRs are typically password-protected and have built-in security features that can protect sensitive patient data from unauthorized access or breaches. We are using Oracle systems and they have certain level of safeguard for security.
Increased Efficiency: EMRs can help reduce the time and effort required to manage and maintain medical records, and enable healthcare providers to access patient data more quickly and easily. Biggest impact is in supply chain management.
Better Data Accessibility: EMRs can enable healthcare providers to access patient data from multiple locations, which can help improve care coordination and communication. By using Google Studio, ethnic health leaders can make decision quicker.
Disadvantages:
High Initial Costs: Implementing EMRs can be expensive, particularly when it comes to purchasing and installing the necessary hardware and software. Oracle is not cheap.
Lack of Standardization: EMRs can have different interfaces and features, which can make it difficult to switch between different systems. Although DHIS 2 is designated as a national platform, different organization use different platform and fragmentation exist.
Lack of Training: Many healthcare providers may be uncomfortable with using EMRs, particularly if they lack the training required to use them effectively. Even in my organization around 30 clinics out of possible 117 clinics are trained, we have a long way to go.
Resistance to Change: Healthcare providers may be reluctant to adopt EMRs due to the perception that they may slow down the care process or cause more hassle in the daily operations. Clinic-in-charge don’t want to use EMR and they want to stick to paper-based systems.
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About 7 years ago, I had the opportunity to be in a transition period from paper-based medical records to electronic medical records. With the implementation of the electronic medical record, there are many benefits, challenges, and concerns.
Benefits
1. Time savings. Implementing electronic medical records can reduce time spent on many processes, for instance, delivery of laboratory request forms and prescription notes, delivery of previous medical record files, etc.
2. Increased cost effectiveness. Healthcare providers can access electronic medical records to review laboratory results and medication which has been ordered by other physicians. This leads to reduction in investigation duplication and double medication. Therefore, unnecessary hospital expenses are reduced.
3. Error reduction. Laboratory critical value, prescription errors, notification of drug interaction, drug allergy can warn healthcare providers.
4. Reduce paper use. After electronic medical records are implemented, the amount of paper used for healthcare services is significantly reduced.
5. Future innovation development. Having prompt data can transform into value information. A clinical decision support system or other artificial intelligence can be developed to improve patient care.
6. Research opportunities. Researchers can use prompt digitalized data from electronic medical records to do research. In addition, it is easier than before that researchers have to manually enter patient data to the computer.
Challenges and concerns
1. Resistance to change from some healthcare personnel. Some medical staffs do not like to change from paper-based medical records to electronic medical records. They may not be familiar with using a computer, worry about their slow typing on the keyboard, or trust on new system.
2. High initial cost. Many information technology have to be purchased, for example, client computers, central servers, network systems, data storage, etc.
3. Security and patient confidentiality. Patient data are kept in servers that can be hacked by malicious users.
4. Prompt support for technical errors. There were frequent errors during the early phase of the implementation of the electronic medical record. Support staff should be available whenever users experience technical problems.
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As a physician with experience working in a hospital that uses both paper and electronic medical record (EMR) systems, I have found that there are both advantages and disadvantages to using an EMR system. Here, I will outline some of the key strengths and weaknesses of EMR systems in a hospital setting.
Strengths:
-Improved efficiency in browsing patient history: With EMR systems, accessing a patient’s past medical history is much faster and more efficient than searching through paper records. This is especially beneficial for critically ill patients who require immediate access to their previous medical history in order to receive appropriate treatment.
-Reduced communication errors: EMR systems eliminate the problem of reading errors due to poor handwriting, which is a common issue with paper records.
-Better notifications and statistical reports: EMR systems can provide notifications for potential drug interactions or allergies, as well as summaries of important statistical results, such as the average blood glucose level over the course of treatment.
-Increased completeness of the information: EMR systems provide a more secure and complete way of storing patient information, as compared to paper records which can be lost or damaged.
Weaknesses:
-EMR systems require a learning curve: It takes some time to master the use of an EMR system, and trained assistance is often required for first-time users.
-Transitioning to EMR systems can be difficult: Hospitals that are switching from paper records to EMR systems may face challenges in dealing with both old and new data, which can put a burden on users.
-Network crashes and power outages can disrupt access to EMR systems: These types of issues can cause problems with database access and interrupt the overall operation.
-Increased risk of information leakage: EMR systems may present a higher risk of information leakage compared to paper records.
-Cost implication: Implementing an EMR system can be costly as it requires significant investment in hardware, software, and training.
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In Indonesia, we are still in the transition period from conventional to electronic where not all healthcare facilities have adopted EMR. This transformation has been supported by a Minister of Health regulation issued in September 2022 due to demands from health professionals as there was no clear legal basis for EMR. After the policy was issued, the government mandated that the transition process is ought to be carried out by December 31, 2023.
As a public health practitioner, I do not work directly with EMRs or EHRs. However, I observed this transition process and got some insights about proportionate benefits and drawbacks of applying EMR in this adaptation era.
The benefits of using EMR
Quoting from an article about EMR implementation based on the nurse’s point of view, EMR could reduce multiple medical record numbers among patients. This system is worthwhile in speeding up the search for manual medical record status when a patient visits the hospital. EMR simplifies the access of nurses or doctors to real-time patient information. Integrated EMR makes it possible to update clinical and other information about patients’ personal and medical status.The drawbacks of using EMR
Many things are not ready yet when facing a transition period, both at the individual and organizational levels. Most think that EMR is about how to record patient medical data and diminish errors. Healthcare providers focus on investing in training the staff without considering other aspects such as reforming workflows, preparing funds and devices, securing internet and electricity, and maintaining data confidentiality. This unpreparedness raises the assumption that the application of EMR creates many technical weaknesses. -
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I’m currently in Private Pharmacy settings without EMR or paper medical records. Since the patient visits are usually quick and it’s rare for them to revisit, using Paper medical records wouldn’t be time efficient for Pharmacist and Patient/customer because these probably could not be used again without data networking. Anyway, I could see the possibility and benefit of data which is recorded electronically and shared in networks between healthcare units and pharmacies
Benefit
Increased treatment and service quality in Pharmacy. Because of data recorded and networking, pharmacist would receive the previous medical record which contains useful data such as medicine history. The problem of medical allergies, replication of treatment and drug interaction might be mitigated from using the shared record. Patients wouldn’t have to bring their current medicine or Pharmacists wouldn’t have to rely on patient recognition of their medical history. These will increase the rational drug use and safety treatment outcomes.Concern
Filling out the electronic record would slow the service, while Pharmacies represent convenience and fast access of healthcare. These might not be easy to get compliance from customer/patient.Increased workload which might lead to Pharmacist’s compliance or resistance.
Data violence from data networking. Because increasing units are involved with data, security of data is a risk from both system management and user side.
Company policy influencing the scope of sharing. Pharmacies are in the private section. Some data probably couldn’t be shared to competitors which would be the barrier to reaching large unit networking.
High initial costs and maintenance of the system. Infrastructure and human cost would be expensive and suspend the development.
From my ideas above, there are many concerns compared to benefits received, therefore using EMR might not be worth to do. These would be complex implementations if electronic records were to be introduced in Thailand Pharmacy settings.
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As I am working as a CRA. I am not quite familiar with medical record of the hospital in term of patient. care.
I tried to summarize what I experienced during internship and in my CRA perspective.
The advantage and the disadvantage of implementing EMR instead of paper-based medical record could be summarized as follows:Advantage(s):
1) Improve the accessibility of the patient medical record: The information could be derived faster and facilitate the patient care service during the prime time of the day comparing to searching the patient OPD binder one by one. The medical record could be viewed by different people at different location at the same time.
2) Meet the stakeholder need including the policy maker, healthcare insurance and enable data exchange among the stakeholders. This would allow the rapid reimbursement process.
3) Improve the quality of care: the OPD record would be more standardized and reduce the errors occurred in patient care.Disadvantage(s):
1) Proper training is required during transition period since the user may not be familiar with the system.
2) Risk of confidentiality of the data held under the EMR system: Since the data would be kept in the electronic way. The security measures are not the same with the paper based EMR. The storage and the use of data should be complied with the local law and regulation as well.
3) Need of provision of the technical support
4) The concern of sustainability of the infrastructure including cost of set up and maintenance. Apart from that, the inadequate maintenance process may lead to the user rejection and could lead to the problem in the future. -
From my point of view, implementing EMR has pros over cons. Below are what I think of advantages and disadvantages from implementing EMR:
Advantages:
– Ease for services and patients: patients and their care givers don’t have to carry document paper from one department to other departments since everything is electronically recorded.
– Enhance patient’s safety: for example, in my setting when assistant pharmacists don’t have to transcribe physician’s handwritten order into the computer program for ordering medicines. This potentially reduce transcribing error which is one of medication errors.
– Increase efficiency: patients’ medical records can be retrieved easily as just input hospital number. Thus, patients’ information can be used among departments (physicians, nurses, laboratory, pharmacy, or cashier). In addition, we can compare current medications ordered by physician versus patients’ own medication or medications from previous visit. This is an important step that pharmacists, who will meet patients at the last step of visit, can confirm the change that was made with patients. Most of the time, I found inconsistency between progress note written by physicians, order prescribed by physicians, and what patients acknowledged. Thus, this also enhance patient’s safety.
– Administrative and management: nurses can print doctor’s appointment from the program. In addition, medical records can be retrieved electronically without time consuming in finding 10 years ago paper-based medical records in storage area.
– Improve data quality: including data collection and integrity of data. Since we have to record information into computer. There will also be a must-filled item that cannot be omitted so, we can ensure that data is completely filled when implementing EMR. In addition, the locked access system to those authorized will ensure confidentiality of patient’s medical records.Disadvantages:
– Perception to change: it is important to know if users have good intention and perception of system changes.
– Workload: in an early stage of implementation, I can say that there are tremendous efforts to make it success. Users have to learn how to use the system, it takes time for them to get familiar with the new one. Instead of inputting information electronically, some people also write down into paper before transcribing into computer because lacking expertise. Thus, this could discourage new users at some point.
– Training: we must ensure that all departments and stakeholders that will get involved in the system have trained prior to system implementation.
– System availability: IT staff must be available at all time. Users will be at ease and don’t have to worry if they face any problem because they know that there are IT staff available for helping them.
– Infrastructures: not only hardware and software but also internet supply and power outlet. We must ensure that we have plan B when system down or network down.
– Financial: by implementing EMR, for sure, we have to invest a lot of money in many parts of the project including manpower and IT related equipment.
– Data integrity and confidentiality/ Security: EMR must have highest security system to prevent personal data leak to unauthorized parties or access. By having good security system, we can assure that patient’s medical records were stored confidentially. -
In my hospital setting, using EMR for a decade, I would say it is worth implementing technology in health system.
Advantages
Better security
– Medical records are contained with confidential patient information. Electronic records can be protected with robust encryption methods to keep crucial information secure.
– With EMR system, we can grant access only to authorized users. We can control who can access the information and when and also monitor Or audit trail to tracking if there’re misuse in the system.
– Data backup after disasters is one important issues that EMR could cover better then paper-based records.
Better service quality
– With EMR, multidepartment clinics can share related important information of patient in order to create holistic approach care.
– It can reduce the frequency of medical errors such as, unclear handwriting medical prescription, duplicate order testing.
– We can set clinical decision system to alarm or alert, for example drug allergy alert pop up box.
Less time and space and cost
– Digital record need less space for storage and easier to pull up when needed. We could access from any devices with authorized account instead of making a request for past medical record that is not available in the moment.
– The system could reduce overall operational costs in long run.
Research support
– With benefit of systematic storage over long period, we can use those information in many research, make it easier to conduct long-term clinical researchChallenges and barriers
>> EMR implementation period : initial phase was quite challenge for all of us as users especially senior staff. It took time to get use to the system and of course disturb workflow in the clinic.
>> Currently, everyone are familiar with the system, the issues in everyday use probably from the system interface itself and IT support. There are still developing and upgrading more functional tools and interfaces. -
Since last 4-5 years ago, I have joined a private hospital as an IPD pharmacist. During that time, the hospital had recently implemented the electronic medical records (EMR) and encouraged healthcare workers to use it instead of paper-based medical records. It took a long period to fully utilize the EMR as it is a major change of workflow in the department. Please let me share the pros and cons of using EMR as the following.
Pros:
– Considering patient safety, EMR could reduce risk of medication errors. For examples,
— Prevent prescribing error; EMR system included clinical decision supports such as suggested dosing regimens, aware of adverse events, drug allergy and interaction alertness. EMR provides better prescription with a complete regimen without abbreviation
— Prevent dispensing error from misreading of handwritten prescription
Therefore, improve process quality– Controlling accessibility level: EMR requires username and password to log-in and limited access for different types of users. Thus, better patient health data security and privacy
– Tracking on data changes over time
– Better communication interoperability
Cons :
During transition of EMR, the design of user interface may not be applicable to most senior staff users and moreover, time consuming for learning new systems and operation. Sometimes, electricity failure could affect the EMR system down time. If EMR has a low security process, it could be a risk of cyberattack.Training of staff/personnel and encouraging the benefits of using EMR are important keys during the initiation. Later on, the feedback and complaints from direct users are essential to system development.
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Using EMR instead of the traditional paper-based medical records has various advantages. Especially we are currently living in the era of “data-driven decision”, digitising the data gives us an opportunity to utilise them without having to use manpower alone.
Let’s start with the advantages of using EMR instead of paper-based medical record first.
– Improved efficacy and patient care deliveries — unlike traditional paper-based medical record where doctors and staffs are needed to fill in the physical form, the data is instantly available after form submission by any staffs who need to use them.
– Decrease legibility problem — as many of you may have heard that some physicians’ handwriting are very hard to read, typing them in a computer will certainly help with this problem!
– Improved data archive efficiently — data is stored in a digital format, so there is no need to keep them in an enormous pile of paper, which can pose a significant risk of catching fire. Also, it can be backed up periodically and send to other places rapidly.
– Increased data utilisation — data collected via an EMR, if collected properly, it can be easily used without having to manually review the paper and fill them in the computer over and over again.
– Improved data security — if data governance is properly applied, we can ensure that the data is stored securely with only authorised level of user can access.What about the disadvantages?
– The more easier data access, the more dangerous they can be. Especially if the data security isn’t implemented properly or carefully enough, it may lead to data breach and personal data violation.
– People with little experience in digital literacy may struggle at first, or during the transitional period. It may cause distress and lead to reduced patient care efficiency because they need to focus on how to use the new thing.
– The infrastructure of new EMR needs specialised profession to ensure the quality of data, data validation, data integrity, secure data transmission. This includes data engineers, data scientists, computer engineers, network engineers, system administrator, etc. which can be costly.
– Most EMR systems have centralised database and servers, in case they fail, a replica is needed to operate instantaneously to prevent downtime. Also, user support is a crucial part to successful EMR implementation. -
Electronic medical records (EMRs) have several advantages over traditional paper-based medical records in healthcare. Benefits of EMRs include:
Improve communication between hospital staff: EMRs can share patient information among healthcare providers, making it easier to coordinate care and avoid duplication of tests or treatments and help to reduce costs.
Improved efficiency and productivity: EMRs can be accessed quickly and easily by authorized hospital personnel, reducing the need to spend time searching for physical records.
Increased accuracy and completeness of patient information: EMRs can also alert healthcare providers to potential errors or omissions, and they can include more detailed information than paper records.
Improved patient outcomes: EMRs can assist healthcare providers in making decisions based on more information, which can improve patient outcomes.EMRs can also have some disadvantages, such as:
Setup fees & Initial costs: Implementing an EMR system can be expensive and may require significant investment in hardware and software.
Staff training: Staff may need to be trained on how to use the EMR system, which can be time-consuming and costly.
Interoperability: There are issues with data sharing and continuity of care because EMRs from different vendors don’t always talk to each other well.
Data security: EMRs store sensitive patient information and proper security measures must be in place to protect this information from unauthorized access or breaches.
Technology dependence: Because EMRs are based on technology, access to patient data may be lost if the system fails. -
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