Abstract
Background:The adoption of electronic medical records (EMRs) in lower-income nations has progressed slowly due to the lack of adequate infrastructure, funding, and training. However, EMRs have been successfully implemented previously in resource-limited health systems in South Africa, Haiti, Cameroon, Kenya, and Peru. Detailed, organized, and easily accessible medical records are particularly important in emergency departments due to the volume and acuity of the patient population.Methods:In order to further study the plausibility of an EMR in a resource-limited emergency department, a web-based, Spanish-language EMR known as SABER was developed for use in Hospital Nacional José Felipe Flores in Totonicapán, Guatemala. The software collects patient data including demographics, triage, initial evaluation, review of systems, physical exam, and evaluation and plan. It then generates a .pdf file consistent with information requirements of the Guatemalan Ministry of Health. Local physicians, medical students, and nurses were trained in the use of the software, which debuted in July 2016. To assess the effectiveness of SABER as an EMR, focus groups and Likert scale surveys were conducted with six physicians and 31 medical students working in the Hospital Nacional emergency department.Results:Thirty of 32 medical students and six of six doctors would recommend SABER to another provider. Positive aspects identified by staff include ease of use, quick data entry, and the potential for large data set research.Discussion:Remaining challenges include incorporating electronic nursing orders and lab results, troubleshooting technology problems including printer difficulties, a lack of electronic signature capability, and lack of integration with the rest of the hospital. Our study is consistent with other studies that show use of an EMR may help to reduce health disparities through improved patient records, medical data collection, and organization.
Highlights
The quality of continuing service and support for SABER was reported to be appropriate by medical students, with 26 out of 31 (84%) agreeing or strongly agreeing that University of Virginia-Guatemala Initiative (UVA-GI) provided continuous and appropriate support to use SABER, and 24 out of 31 (78%) agreeing or strongly agreeing that UVA-GI provided the training necessary to use SABER
Four out of six (66%) doctors agreed or strongly agreed that the support provided by UVA-GI for SABER was appropriate
Zero medical students or physicians reported on the survey that they were unsatisfied with the SABER system
Summary
Electronic Medical Record (EMR) Adoption in High-Income Countries The potential benefits of electronic medical record systems (EMRs) in high-income countries have been well described. A 2014 survey of 6,375 American providers revealed that physicians who used EMRs had lower satisfaction with the amount of time spent on clerical tasks and higher rates of burnout [11] Given these challenges and many others, it is important to the success of a given EMR to perform a detailed cost-benefit analysis. The software collects patient data including demographics, triage, initial evaluation, review of systems, physical exam, and evaluation and plan. It generates a .pdf file consistent with information requirements of the Guatemalan Ministry of Health. Our study is consistent with other studies that show use of an EMR may help to reduce health disparities through improved patient records, medical data collection, and organization
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