Electronic Medical Records at ISS Clinic

Student Name: Naga Hussain Rao
Student Number: 19571001
PHE5ALS Action Learning Studies Assessment Task2
Project Report
Electronic Medical Records at ISS Clinic
Mbarara, Uganda.
Naga Hussain Rao
Student- Researcher
ISS Clinic
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Student Name: Naga Hussain Rao
Student Number : 19571001
Executive Summary
The Electronic Medical Record (EMR) implementation has increased a lot in different
countries. New frameworks were described in different literature to understand the best practices of
EMR and EMR implementation in a successful way. The main focus of this study is to provide the
evidence-based report on best practices in EMR implementation and also providing the necessary
recommendations to the ISS Clinic. In this study, the method explains the review of different
studies by using different databases and extracting the necessary data to provide the best
deliverables for the project. Since 2004, The ISS clinic members and the supporting organisations
working on EMR to get the patient data into electronic database. This may also include 1,000
patients who are getting antiretroviral therapy (ART) records. By 2010, there are nearly 10,000
patients were getting antiretroviral therapy at ISS clinic so, operating become more sophisticated
and expensive. In 2011, 10% of Ugandan population had access to electricity, however, the need
and the demand for information technology (IT) resources was highly increasing. It was found that
EMR systems possess the ability of an improved keeping of patient records, billing and claims.
Tangible improvements for the organization and safe treatment are provided by the EHR’s by
exchanging necessary information by EMR.
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Student Name: Naga Hussain Rao
Student Number : 19571001
Table of Contents
Executive Summary.............................................................................................................................2
Introduction and Background...............................................................................................................4
Project Goals and Objectives...........................................................................................................6
Literature Review.................................................................................................................................6
Methods................................................................................................................................................7
Results or project outcomes.................................................................................................................8
Discussion............................................................................................................................................9
Conclusion and recommendation.......................................................................................................13
Appendices.........................................................................................................................................16
Literature Review...........................................................................................................................16
Deliverables and Evaluation...........................................................................................................23
Gantt chart......................................................................................................................................24
Stakeholder Management Plan and Report....................................................................................25
Risk Assessment.............................................................................................................................27
Mitigation and Outcome Report.....................................................................................................29
Budget of the project......................................................................................................................30
References..........................................................................................................................................31
Checklist for submission....................................................................................................................34
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Student Name: Naga Hussain Rao
Student Number : 19571001
Introduction and Background
The main focus of health care providers is the importance of quality of care which cope up with
the changing demand, adopting fast-paced health systems. In this way, the electronic medical record
systems (EMR) have been becoming the standard to improve patient satisfaction and the quality of
care. The EMR has changed the way of maintaining the patient medical history and allow the
physicians to keep all information at one place. This type of system enhances the efficiency and
effectiveness of health care. According to the statistics, the usage of EMR by the office-based
setting is about 29.2% which indicates that there is an increase of EMR use around 22% in
comparison with 2005 (Raymond et al., 2015). So, the usage of EMR has been rising in a quick
manner because the health care staffs are more concern about the patient information which makes
help in decision making process. Previously, the health care system may use paper-based records
for patient information. Paper records are less reliable, and the quality of the records may
deteriorate upon overtime usage in terms of fax, copying the original and other factors (Ben-Assuli,
2015). There are different problems in accessing patient information. The organisations like the
Future of Family Medicine and the American Medical Association are tried to use of Information
technology (IT) in health care to improve the quality and efficiency (Irani, Middleton, Marfatia,
Omana & D’Amico, 2009). There are a lot advantages with the new system. They are:
 Reduce medical errors and adverse events.
 Better documentation and file organization
 Provide patients with information that helps in treatment processes like medication regimens
and scheduled appointments.
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Student Name: Naga Hussain Rao
Student Number : 19571001
 Assist doctors in tracking their past and current treatment protocols
The Idea of converting all the Patient information into a health record was originated in the mid-
1960s by Larry Weed. In 1972, Regenstrief Institute developed the EMR system (Xu & Papier,
2018). At the early stage the system was not attractive to the physicians due to the high costs and
other parameters. In 1990’s, when the personal computers and the internet emerged then the setting
of web-based EMR has started. The emergence of web-based software for electronic medical record
systems has developed and the remote system has become evident (Zaidan et al., 2015). The ability
to maintain, store and access the data remotely becomes more convenient to physicians. After the
success, most health care organisations are called for adaptation of EMR by the year 2014.
Implementation of electronic medical records (EMR) by the ISS clinic in Uganda to offer care
to HIV-positive patients may provide a lot of benefits to the system in terms of improving the
working conditions, medical records and quality of patient care (Jazayeri et al., 2015). These EMR
may also useful for the purposes like the ability to store, exchange and utilize patient’s information
quickly and legibly rather than the use of paper records. An EMR system will allow the patient
which includes assisting in tracking patient medications, reducing medical mistakes such as
prescription errors, regarding lab results, reduce billing miscalculations, increase provider
reimbursement and create patient summaries for referrals.
Even though there are potential benefits with this system, it is important to review the
drawbacks and controlling the data usage for the purpose. The use of EMR system should have the
concern about the use because; this type of technology may cause some apprehension for patients,
physicians and staff. Privacy and confidentiality issues are the major issues for patients as
computers pose a greater threat to privacy and are vulnerable to unauthorized access. Nowadays, the
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Student Name: Naga Hussain Rao
Student Number : 19571001
electronic database may get access by unauthorised persons and easily misused or theft in terms of
hacking.
The next issue is competency amongst providers and staff. It is important that the staffs who are
involved in dealing with the data get trained properly for the better maintenance of the records.
Communication and education were also an important issue because patients who don’t have any
educational background. They may be unwilling to be completely frank about their problems with
the working team. Finally, the most important aspect was patient satisfaction. It is very important to
maintain positive relationship with the clients. These may happen only when the patient gets quality
of care on a continuous basis.
Project Goals and Objectives
The goal of this study is to find out the evidence-based best practices with the new approach
by combining the literature to ensure successful implantation of EMR.
The objectives of this study are:
 Provide a report on evidence-based practices.
 Submit the evidence to support the report.
 Review the effectiveness of data
 Necessary recommendations for better implementation of EMR.
Literature Review
The literature review on EMR practices was conducted from various resources such as
research base, Gray literature academics and promotional strategies. The Databases were reviewed
for selected articles and analysed. Abstracts of related research studies on EMR are to be reviewed
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Student Name: Naga Hussain Rao
Student Number : 19571001
an analysed. This may also indicate necessary recommendations for better implementation of EMR
where it requires (Boonstra, A., Versluis, A., & Vos, J.2014). These may help to provide effective
and efficient services to the patient and increases patient satisfaction rates. There are different terms
used to broaden or narrow the search which includes AND, OR, NOT and other. The signs are used
to extend the search terms.
Search terms included:
 Electronic Health Record
 Implementation
 Clinics
 Developing countries setting on EMR
 Recommendation on EMR.
The supporting pieces of evidence were provided in the section of appendix 1. There is different
systematic literature which providing data on challenges in EMR and the solutions, developing
country setting on EMR implementation and other.
Methods
Relevant literature has been searched in online databases like Elsevier, Medline, Pub Med
and Science Direct to retrieve relevant literature surrounding the topic of Electronic Medical
Records (EMR). The project has been designed to understand the prevalence of EMR in the region
in accordance with the organization which had conducted. The list of deliverables of the project is
available in appendix 1(2). A plan was created which is presented in appendix 1 (4), which was
planned to prepare, collect, analyse and conclude the project that is going to be conducted. For the
preparation stage, all the information with necessary background about the electronic medical
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Student Name: Naga Hussain Rao
Student Number : 19571001
records with collection of relevant data has been reviewed. A considerable amount of time was
allocated for reviewing the data. In the data collection stage, a plan was created to list out all the
relevant databases that will be searched. Relevant criteria for inclusion and exclusion had to be
found with relevant search terms. The search terms will enhance the search by narrowing down to
exact similar research articles encircling our topic. For efficient analysis of the data, research
articles which had adopted qualitative methods to find appropriate results have been shortlisted and
their results were reviewed.
In this study, there is no concern about ethical issues. It is a review of literature from various
sources to find best practices with recommendations. There is no need to disclose any personal
details and other patient records that affect privacy and confidentiality. Though an electronic
medical record (EMR) is widely being used by the developing countries as it improves the quality,
efficiency effectiveness and patient satisfaction, in other hands, the advancement in technology can
introduce some hazards like disclosing patient data without any prior authorisation in terms of
hacking. Recently, there are a lot of cases has found out so there is a need to address these sort
issues in recommendation. Otherwise, it won’t fulfil the best practices criteria (Balestra, M. 2017).
Results or project outcomes
As the ISS centre was utilizing paper-based reports there were different difficulties which
were getting to be hard to deal with. In any case, as the Electronic Medical Record (EMR)
frameworks were executed it permitted in better coordination and sharing of the medicinal records
crosswise over human services associations. EMR frameworks can improve record continuing,
charging and guarantees the executives. EHRs can trade wellbeing data electronically and can help
give better quality and safe treatment for the patients while making substantial enhancements for the
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