The Lifesaving Impact of Electronic Medical Records for HIV Patients

This study was designed to evaluate the impact of electronic medical record (EMR) implementation on quality of diabetes care. We conducted a 5-year longitudinal study of 122 adults with diabetes mellitus at an intervention (EMR) clinic and a comparison (non-EMR) clinic. Clinics had similarly trained primary care physicians, similar patient populations, and used a common diabetes care guideline that emphasized the importance of glucose control. The EMR provided basic decision support, including prompts and reminders for diabetes care. Preintervention and postintervention frequency of testing for glycated hemoglobin (HbA1c) and low-density lipoprotein (LDL) levels were compared with and without adjustment for patient age, sex, comorbidity, and baseline HbA1c level. Frequency of HbA1c tests increased at the EMR clinic compared with the frequency at the non-EMR clinic (P < .001). HbA1c levels improved in both clinics (P < .05) with no significant differences between clinics 2 years (P = .10) or 4 years (P = .27) after EMR implementation. Similar results were observed for LDL levels. In this controlled study, EMR use led to an increased number of HbA1c and LDL tests but not to better metabolic control. If EMRs are to fulfill their promise as care improvement tools, improved implementation strategies and more sophisticated clinical decision support may be needed.

Allied health professionals’ experiences and lessons learned in response to a big bang electronic medical record implementation: A prospective observational study

The present study aimed to assess the impact of a hospital-wide electronic medical record (EMR) on the way dietitians collect routine data for their assessments and its impact on their clinical documentation and service provision. Data were collected retrospectively from the following sources: interdepartmental chart audit, the EMR itself (nutrition diagnosis), National Health Roundtable database (admissions requiring nutrition events) and the hospital-wide Pressure Injury Prevention Audits (height, weight and malnutrition screening). There were improvements in medical record accessibility (76.4% pre vs 100% post, P < 0.001), awareness of medical alerts (82.5% unaware pre vs 34.5% unaware post) and legibility of documentation (53.8% pre vs 99.2% post, P < 0.001). Improvements in accessing medical charts under 1 minute also occurred (65.8% pre vs 99.2% post, P < 0.001). The percentage of nutrition diagnoses resolved during admission increased from 20.0% in February 2016 to 34.0% in August 2017. A 72.0% increase in admissions requiring nutrition interventions was found with 4075 admissions pre- and 7035 post-EMR implementation. Time spent per nutrition event reduced by 22.0% (118 minutes pre and 92 minutes post). Hospital audit data revealed mean height and weight collected increased from 79.3 ± 3.8% (n = 8 audits totalling 3041/3834 patients) to 86.0 ± 2.6% (n = 5 audits totalling, 2544/2958 patients) post-EMR with malnutrition screening completion increasing from 57.5% to 74.0%. Findings indicate that EMR implementation has the potential to benefit the dietetic profession due to the potential to enhance the capacity and efficiency of dietetic departments.

BackgroundReports on the impact of electronic medical record (EMR) systems on clinicians are mixed. Currently, nurses’ experiences of adopting a large-scale, multisite EMR system have not been investigated. Nurses are the largest health care workforce; therefore, the impact of EMR implementation must be investigated and understood to ensure that patient care quality, changes to nurses’ work, and nurses themselves are not negatively impacted.ObjectiveThis study aims to explore Australian nurses’ postimplementation experiences of an organization-wide EMR system.MethodsThis qualitative descriptive study used focus group and individual interviews and an open-ended survey question to collect data between 12 and 18 months after the implementation of an EMR across 6 hospital sites of a large health care organization in Victoria, Australia. Data were collected between November 2020 and June 2021, coinciding with the COVID-19 pandemic. Analysis comprised complementary inductive and deductive approaches. Specifically, reflexive thematic analysis was followed by framework analysis by the coding of data as barriers or facilitators to nurses’ use of the EMR using the Theoretical Domains Framework.ResultsA total of 158 nurses participated in this study. The EMR implementation dramatically changed nurses’ work and how they viewed their profession, and nurses were still adapting to the EMR implementation 18 months after implementation. Reflexive thematic analysis led to the development of 2 themes: An unintentional divide captured nurses’ feelings of division related to how using the EMR affected nurses, patient care, and the broader nursing profession. This time, it’s personal detailed nurses’ beliefs about the EMR implementation leading to bigger changes to nurses as individuals and nursing as a profession than other changes that nurses have experienced within the health care organization. The most frequent barriers to EMR use by nurses were related to the Theoretical Domains Framework domain of environmental context and resources. Facilitators of EMR use were most often related to memory, attention, and decision processes. Most barriers and facilitators were related to motivation.ConclusionsNurses perceived EMR implementation to have a mixed impact on the provision of quality patient care and on their colleagues. Implementing technology in a health care setting was perceived as a complex endeavor that impacted nurses’ perceptions of their autonomy, ways of working, and professional roles. Potential negative consequences were related to nursing workforce retention and patient care delivery. Motivation was the main behavioral driver for nurses’ adoption of EMR systems and hence a key consideration for implementing interventions or organizational changes directed at nurses.

The impact of electronic medical record systems on outpatient workflows: A longitudinal evaluation of its workflow effects

This Rapid Evidence Assessment (REA) aimed to investigate the impact of electronic medical record (EMR) implementation on the process and outcomes of nursing handover by synthesising the existing scientific literature. Clinical nursing handover involves transferring patient information, responsibility and accountability to ensure continuity of care and patient safety. Poor or absent clinical handover can negatively impact quality of care, patient safety and patient outcomes. EMRs are patient information systems that facilitate the real‐time sharing of patient data. It has been proposed that EMRs may assist in addressing communication issues often associated with poor nursing handover, yet the implementation and impact of EMR implementations remain varied. A database search was conducted in PubMed, CINAHL and Cochrane. Articles for inclusion were studies in which the impact of an EMR implementation was evaluated, where participants were nurses performing handover from shift to shift in a hospital setting. Eleven studies from 4 different countries were included. The study findings revealed 4 broad themes that serve to answer the research question: use of the EMR during handover; nurse perceptions and satisfaction with the EMR; barriers to use; and enablers to use. EMR‐mediated handover was described in 7 studies. EMR‐structured handover was described in 7 studies. EMR‐generated printouts were described in 4 studies. While the EMR was routinely used to validate and check certain pieces of information during handover, nurses considered their personalised paper‐based forms to be the preferred handover tool. The main findings were that nurses generally expressed dissatisfaction with using the EMR to facilitate handover, with three studies reported dissatisfaction with EMR‐based handover. 50% of nurses found printouts cumbersome, and 69% reported irrelevant information. Barriers to EMR use included 6 studies that identified design‐related barriers. 4 studies emphasised the importance of cognitive support and situational awareness. 4 studies highlighted the lack of nursing engagement and codesign. 5 studies discussed variations in nurse digital literacy. Enablers to EMR use included two studies highlighting the importance of nurse engagement and codesign in successful EMR‐facilitated handover. Three studies showed nurses deliberately adopting EMR‐based handover tools, contrasting with previous examples of forced adaptation. No single tool was able to provide nurses with the whole patient story, the required situational awareness, nor the cognitive support required to convey and receive information during handover. An effective EMR‐mediated solution that improves the efficacy and quality of nursing handover has not yet been realised. Future efforts to design EMR‐mediated solutions to better support nurses must fully appreciate the complexities of nursing handover, the mental workload associated with the task and the definitive qualities of tools to provide this support. This REA has demonstrated the need for clinical nurses to be more directly involved in the iterative development and evaluation of these tools in order to specifically enhance processes and outcomes of nursing handover.

The development of information technology is now growing rapidly, including in the health sector. According to WHO, medical record is an important compilation of facts about a patient's life and health. The development of information technology in medical records is the electronic medical record (EMR). Developed countries, such as the United States and Korea have implemented EMR for a long time. In developing countries such as Indonesia, the development of EMR is still in progress because its implementation requires many factors to build a system or replace from manual medical records. Eventually, it is hoped that in the future all health care will use the EMR to resume patient datas from admission to discharge. The purpose of this study is to analyse the implementation and preparation of EMR in health care in Indonesia. This study is a literature review on the implementation and preparation of EMR in health care in Indonesia. The review is dome from 28 literature sources (Google-Scholar database). Total of 8 articles were obtained from 2017 to 2021. The results show that there are benefits after switching to EMR, even though some health care only used EMR in certain units. The highest benefit is reducing the cost of duplicating paper for printing. Also there is still limited human resources and tools for implementing EMR in Indonesia. The implementation of this EMR will enable the improvements of the service quality of the health care itself, especially in Indonesia.

EMRs have been globally recognized as transformative tools in modern healthcare, improving efficiency, enhancing patient outcomes, and reducing operational costs. This study explores the impact of Electronic Medical Records (EMR) adoption on cost reduction in healthcare facilities in Nigeria, using Reference Hospital, Okene, Kogi State, as a case study. The study examines the relationship between EMR adoption and cost savings, addressing Nigeria’s pressing healthcare challenges such as high out-of-pocket expenses and inefficient resource allocation. A descriptive survey design and cross-sectional approach were employed, with data collected from 108 senior and management staff across various departments. A structured questionnaire, analyzed using SPSS 27.0, provided insights into the correlation between EMR implementation and operational cost reduction. Principal Component Analysis (PCA) identified three key cost-saving components, which were correlated with EMR adoption using Spearman’s rank correlation. Findings reveal that EMR adoption significantly reduces administrative tasks, enhances inventory management, and minimizes costs associated with medical errors and adverse events. However, initial implementation and maintenance costs remain challenges. The results demonstrate a statistically significant relationship between EMR usage and cost-saving components, validating the hypothesis that EMR systems improve operational efficiency and affordability in healthcare delivery. The study concludes that EMR systems offer a viable pathway to cost reduction and improved healthcare outcomes. It recommends scaling up EMR adoption in Nigerian healthcare facilities, supported by government policies, funding, and staff training. Future research should explore long-term impacts, regional variations, and challenges specific to rural healthcare settings.

This study investigated the impact of the Electronic Medical Record (EMR) system on the performance of PCEA Chogoria Hospital in Tharaka Nithi County, Kenya. The adoption of Electronic Medical Records systems in healthcare facilities has become increasingly prevalent globally, promising enhanced efficiency, cost-effectiveness, and improved access to patient information. Employing a mixed-methods approach, combining qualitative and quantitative techniques, the study explored the perceptions and experiences of healthcare providers regarding EMR utilisation. The study's theoretical framework draws from institutional theory and the theory of change. Data collection involved the administration of questionnaires and interviews with 100 technical staff members, including clinical professionals, nurses, and medical records information officers working at PCEA Chogoria Hospital. The analysis revealed significant improvements in access rights, reporting and analysis functionalities, and clinical management support, indicating the overall positive impact of the EMR system. However, opportunities for further enhancement in customisation and utilisation were identified. Additionally, strategic budget allocation and resource provision were crucial for effective EMR initiatives, emphasising the importance of targeted training programs and transparent communication. Administrative support was highlighted as essential for successful EMR implementation and utilisation, underscoring the need for continuous evaluation, training, and reinforcement of roles and responsibilities. In conclusion, the findings underscore the significant impact of Electronic Medical Records (EMR) systems on the performance of PCEA Chogoria Hospital. Recommendations include investing in targeted training programs, transparent communication channels, and resource allocation strategies to optimise the impact of EMR systems on healthcare delivery and patient-care outcomes.

Purpose: To describe processes, opportunities and challenges encountered by an acute care rehabilitation department during electronic medical record (EMR) implementation. The EMR can enhance quality, safety and efficiency but hospital adoption has been slow. Due to widespread support and financial incentives, implementation of certain areas of the EMR, such as medication administration and order entry, has become more prevalent. Methods: During the design phase of EMR implementation, rehabilitation managers participated in several committees including system development and hospital infrastructure hardware assessment. For rehabilitation staff, EMR education was multimodal utilizing a train-the-trainer approach, including computer-based training, face-to-face, and classroom education. Due to resource constraints, the Information Technology department provided limited support to build and implement rehabilitation EMR documentation. The rehabilitation department took the initiative to internally develop and implement electronic documentation utilizing tools offered within EMR software. Results: Average visits temporarily declined by 13.7% for PT and 8.4% for OT during EMR implementation; the volume of treatments returned to previous numbers after implementation. EMR implementation decreased the need for aide staff to spend time and resources to support the paper medical record. Conclusion: EMR committees offered a direct line to provide input and troubleshoot EMR issues and increased awareness of options and processes. This empowered the rehabilitation department to seek creative ways to develop electronic documentation.

Background The intent of this review is to discover the types of inquiry and range of objectives and outcomes addressed in studies of the impacts of Electronic Medical Record (EMR) implementations in limited resource settings in sub-Saharan Africa. Methods A state-of-the-art review characterized relevant publications from bibliographic databases and grey literature repositories through systematic searching, concept-mapping, relevance and quality filter optimization, methods and outcomes categorization and key article analysis. Results From an initial population of 749 domain articles published before February 2015, 32 passed context and methods filters to merit full-text analysis. Relevant literature was classified by type (e.g., secondary, primary), design (e.g., case series, intervention), focus (e.g., processes, outcomes) and context (e.g., location, organization). A conceptual framework of EMR implementation determinants (systems, people, processes, products) was developed to represent current knowledge about the effects of EMRs in resource-constrained settings and to facilitate comparisons with studies in other contexts. Discussion This review provides an overall impression of the types and content of health informatics articles about EMR implementations in sub-Saharan Africa. Little is known about the unique effects of EMR efforts in slum settings. The available reports emphasize the complexity and impact of social considerations, outweighing product and system limitations. Summative guides and implementation toolkits were not found but could help EMR implementers. Conclusion The future of EMR implementation in sub-Saharan Africa is promising. This review reveals various examples and gaps in understanding how EMR implementations unfold in resource-constrained settings; and opportunities for new inquiry about how to improve deployments in those contexts.

Background The intent of this review is to discover the types of inquiry and range of objectives and outcomes addressed in studies of the impacts of Electronic Medical Record (EMR) implementations in limited resource settings in sub-Saharan Africa. Methods A state-of-the-art review characterized relevant publications from bibliographic databases and grey literature repositories through systematic searching, concept-mapping, relevance and quality filter optimization, methods and outcomes categorization and key article analysis. Results From an initial population of 749 domain articles published before February 2015, 32 passed context and methods filters to merit full-text analysis. Relevant literature was classified by type (e.g., secondary, primary), design (e.g., case series, intervention), focus (e.g., processes, outcomes) and context (e.g., location, organization). A conceptual framework of EMR implementation determinants (systems, people, processes, products) was developed to represent current knowledge about the effects of EMRs in resource-constrained settings and to facilitate comparisons with studies in other contexts. Discussion This review provides an overall impression of the types and content of health informatics articles about EMR implementations in sub-Saharan Africa. Little is known about the unique effects of EMR efforts in slum settings. The available reports emphasize the complexity and impact of social considerations, outweighing product and system limitations. Summative guides and implementation toolkits were not found but could help EMR implementers. Conclusion The future of EMR implementation in sub-Saharan Africa is promising. This review reveals various examples and gaps in understanding how EMR implementations unfold in resource-constrained settings; and opportunities for new inquiry about how to improve deployments in those contexts.

Background The intent of this review is to discover the types of inquiry and range of objectives and outcomes addressed in studies of the impacts of Electronic Medical Record (EMR) implementations in limited resource settings in sub-Saharan Africa. Methods A state-of-the-art review characterized relevant publications from bibliographic databases and grey literature repositories through systematic searching, concept-mapping, relevance and quality filter optimization, methods and outcomes categorization and key article analysis. Results From an initial population of 749 domain articles published before February 2015, 32 passed context and methods filters to merit full-text analysis. Relevant literature was classified by type (e.g., secondary, primary), design (e.g., case series, intervention), focus (e.g., processes, outcomes) and context (e.g., location, organization). A conceptual framework of EMR implementation determinants (systems, people, processes, products) was developed to represent current knowledge about the effects of EMRs in resource-constrained settings and to facilitate comparisons with studies in other contexts. Discussion This review provides an overall impression of the types and content of health informatics articles about EMR implementations in sub-Saharan Africa. Little is known about the unique effects of EMR efforts in slum settings. The available reports emphasize the complexity and impact of social considerations, outweighing product and system limitations. Summative guides and implementation toolkits were not found but could help EMR implementers. Conclusion The future of EMR implementation in sub-Saharan Africa is promising. This review reveals various examples and gaps in understanding how EMR implementations unfold in resource-constrained settings; and opportunities for new inquiry about how to improve deployments in those contexts.

BackgroundThe success of electronic medical records (EMRs) is dependent on implementation features, such as usability and fit with clinical processes. The use of EMRs in mental health settings brings additional and specific challenges owing to the personal, detailed, narrative, and exploratory nature of the assessment, diagnosis, and treatment in this field. Understanding the determinants of successful EMR implementation is imperative to guide the future design, implementation, and investment of EMRs in the mental health field.ObjectiveWe intended to explore evidence on effective EMR implementation for mental health settings and provide recommendations to support the design, adoption, usability, and outcomes.MethodsThe scoping review combined two search strategies that focused on clinician-facing EMRs, one for primary studies in mental health settings and one for reviews of peer-reviewed literature in any health setting. Three databases (Medline, EMBASE, and PsycINFO) were searched from January 2010 to June 2020 using keywords to describe EMRs, settings, and impacts. The Proctor framework for implementation outcomes was used to guide data extraction and synthesis. Constructs in this framework include adoption, acceptability, appropriateness, feasibility, fidelity, cost, penetration, and sustainability. Quality assessment was conducted using a modified Hawker appraisal tool and the Joanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews and Research Syntheses.ResultsThis review included 23 studies, namely 12 primary studies in mental health settings and 11 reviews. Overall, the results suggested that adoption of EMRs was impacted by financial, technical, and organizational factors, as well as clinician perceptions of appropriateness and acceptability. EMRs were perceived as acceptable and appropriate by clinicians if the system did not interrupt workflow and improved documentation completeness and accuracy. Clinicians were more likely to value EMRs if they supported quality of care, were fit for purpose, did not interfere with the clinician-patient relationship, and were operated with readily available technical support. Evidence on the feasibility of the implemented EMRs was mixed; the primary studies and reviews found mixed impacts on documentation quality and time; one primary study found downward trends in adverse events, whereas a review found improvements in care quality. Five papers provided information on implementation outcomes such as cost and fidelity, and none reported on the penetration and sustainability of EMRs.ConclusionsThe body of evidence relating to EMR implementation in mental health settings is limited. Implementation of EMRs could benefit from methods used in general health settings such as co-designing the software and tailoring EMRs to clinical needs and workflows to improve usability and acceptance. Studies in mental health and general health settings rarely focused on long-term implementation outcomes such as penetration and sustainability. Future evaluations of EMRs in all settings should consider long-term impacts to address current knowledge gaps.

Electronic Medical Record (EMR) is the digital tool to keep records of valuable information on computer or computer-like equipment, regarding health systems, including patient’s records and stock management which can provide real time evidence for better patient record, clinical care and health policy making. As Nepal does not have a national EMR system, and it is a challenge to get real time data, information and evidence required for effective health policy making. With an effective national EMR system in Nepal, the health system can be improved with reliable information of patients for the continuity of clinical care.&#x0D; &#x0D; There are existing scientific evidence of EMR on the lessons of implementation in Nepal, opportunities for the use of EMR in Malaysia, perspectives of health care workers on EMR after its implementation in Canada, on the development of success measuring tools and the use of questionnaires for the EMR implementation in Canada, best practices, impact of EMR on physician practice, and barriers for EMR implementation.&#x0D; &#x0D; EMR can improve the quality, effectiveness, transparency and efficiency of healthcare services and its management. Gandaki province is one of seven provinces in Nepal and is exploring ways to implement EMR in all the hospitals operated under the province government. There can be step wise approach to have EMR in all of these hospitals. This can give more strategies for the national EMR system.