Electronic Medical Record Adoption Research Articles

Barriers to the Adoption of Electronic Medical Record System in Ethiopia: A Systematic Review

BackgroundElectronic medical records (EMRs) can improve the quality of health care and patient safety. Various countries have gone through the local application of EMRs to various health care organizations in national implementation and integration of EMRs. Ethiopia lags far in the back in this regard, as solely some hospitals have implemented EMR.ObjectiveThis study aimed to identify barriers to the adoption of EMRs in Ethiopia through a systematic review of the literature.MethodsPubMed, Semantic Scholar, and Google Scholar have been searched for applicable articles. The search method focuses on peer-reviewed, empirical research conducted in Ethiopia. The ultimate set that met the inclusion standards was 9 studies. The authors extracted, analyzed, and summarized empirical results associated with EMR barriers in these studies.ResultsThis systematic review identified the following 17 barriers to EMR adoption: absence of EMR training, limited access to computers, insufficient computer literacy, deficiency of EMR knowledge, inadequate technical help, absence of EMR manual, negative attitude to EMR, limited internet access, lack of management support, electric power interruption, absence of perceived system quality, absence of perceived information quality, lack of willingness, the complexity of the system, performance expectancy, effort expectancy, and lack of IT qualification.ConclusionThe most common barriers for EMR adoption are absence of EMR training, limited access to a computer, poor computer literacy, poor EMR knowledge, lack of technical support, and absence of an EMR manual. As this study summarizes the available evidence regarding barriers to adopting EMR in Ethiopia, future research will rest on this evidence and specialize in building a proper framework for EMR implementation in Ethiopia.

Using Electronic Medical Record Data for Research in a Healthcare Information and Management Systems Society (HIMSS) Analytics Electronic Medical Record Adoption Model (EMRAM) Stage 7 Hospital in Beijing: Cross-sectional Study.

BackgroundWith the proliferation of electronic medical record (EMR) systems, there is an increasing interest in utilizing EMR data for medical research; yet, there is no quantitative research on EMR data utilization for medical research purposes in China.ObjectiveThis study aimed to understand how and to what extent EMR data are utilized for medical research purposes in a Healthcare Information and Management Systems Society (HIMSS) Analytics Electronic Medical Record Adoption Model (EMRAM) Stage 7 hospital in Beijing, China. Obstacles and issues in the utilization of EMR data were also explored to provide a foundation for the improved utilization of such data.MethodsFor this descriptive cross-sectional study, cluster sampling from Xuanwu Hospital, one of two Stage 7 hospitals in Beijing, was conducted from 2016 to 2019. The utilization of EMR data was described as the number of requests, the proportion of requesters, and the frequency of requests per capita. Comparisons by year, professional title, and age were conducted by double-sided chi-square tests.ResultsFrom 2016 to 2019, EMR data utilization was poor, as the proportion of requesters was 5.8% and the frequency was 0.1 times per person per year. The frequency per capita gradually slowed and older senior-level staff more frequently used EMR data compared with younger staff.ConclusionsThe value of using EMR data for research purposes is not well studied in China. More research is needed to quantify to what extent EMR data are utilized across all hospitals in Beijing and how these systems can enhance future studies. The results of this study also suggest that young doctors may be less exposed or have less reason to access such research methods.

A mixed-methods study of pharmacy instructors' early experiences with a teaching electronic medical record

IntroductionAs use of electronic medical records (EMRs) increases in healthcare, multiple accreditation organizations recommend training future clinicians on EMRs as part of the academic curriculum. Therefore, some pharmacy programs now utilize an academic EMR. Our objective was to examine pharmacy instructors' early experiences with a commercially available teaching EMR (tEMR) in order to identify current and future priorities along with benefits and barriers to academic EMR use in pharmacy education. MethodsWe conducted semi-structured interviews and a web-based survey with pharmacy instructors. Interview and survey data analyses consisted of hybrid inductive/deductive approaches to coding data and descriptive statistics, respectively. We mapped themes to the Pharmacists' Patient Care Process (PPCP). ResultsSeven instructors participated in interviews, and 10 completed the survey. We identified 25 interview themes that were generally congruent with survey responses. A noted benefit of the tEMR was providing a large repository of real-life patient data. Instructors' current priorities for tEMR activities primarily aligned with “collect,” “assess,” and “plan” steps of the PPCP. One reported barrier was insufficient training regarding the tEMR capabilities. Instructors offered innovative ideas for future academic EMR use, including pharmacokinetics, incident reporting, and longitudinal cases. ConclusionsStudy findings are most applicable to pharmacy programs in the early stages of academic EMR adoption. We identified opportunities for pharmacy programs to facilitate innovative, future use of academic EMRs, including curriculum planning, so pharmacy students gain experience using EMR functions for each PPCP step and develop more advanced EMR skills.

The interaction between high-level electronic medical record adoption and hospitalist staffing levels: A focus on value-based purchasing.

This study sought to understand the relationship of hospital performance with high-level electronic medical record (EMR) adoption, hospitalists staffing levels, and their potential interaction. We evaluated 2,699 non-federal, general acute hospitals using 2016 data merged from four data sources. We performed ordinal logistic regression of hospitals' total performance score (TPS) on their EMR capability and hospitalists staffing level while controlling for other market- and individual-level characteristics. Hospitalists staffing level is shown to be positively correlated with TPS. High-level EMR adoption is associated with both short-term and long-term improvement on TPS. Large, urban, non-federal government hospitals, and academic medical centers tend to have lower TPS compared to their respective counterparts. Hospitals belonging to medium- or large-sized healthcare systems have lower TPS. Higher registered nurse (RN) staffing level is associated with higher TPS, while higher percentage of Medicare or Medicaid share of inpatient days is associated with lower TPS. Although the main effects of hospitalists staffing level and EMR capability are significant, their interaction is not, suggesting that hospitalists and EMR act through separate mechanisms to help hospitals achieve better performance. When hospitals are not able to invest on both simultaneously, given financial constraints, they can still reap the full benefits from each. Hospitalists staffing level and EMR capability are both positively correlated with hospitals' TPS, and they act independently to bolster hospital performance.

Electronic medical records and primary care quality: Evidence from Manitoba

Improvements in quality of care through supporting decision-making processes and increased efficiency have prompted widespread implementation of electronic medical records (EMRs) in Canada. Using a set of indicators of preventive care, chronic disease management, and hospitalizations due to ambulatory care sensitive conditions (ACSC), this study measures the effect of EMR adoption on quality of primary care measures. Population-based data for the Canadian province of Manitoba are used in a difference-in-differences approach with patient- and time-fixed effects. Evidence of changes in the selected quality-of-care indicators is weak, with preventive care, management of asthma, and hospitalizations showing no significant change due to EMR adoption. A statistically significant increase in the quality of diabetes care was found for EMR users, changes being larger for late EMR adopters which is possibly explained by a network effect. This research demonstrates that measuring whether EMRs prompt changes in the quality of care confronts serious challenges. The rapid evolution and gradual adoption of EMR technology, the inevitable learning/acceptance process by individual health practitioners, and its potential reflection on different patient populations create unmeasurable variables that confound EMRs' impact. This study also underscores the importance of data development to support the economic value of EMRs.

Does EMR Adoption by Nursing Homes Decrease Hospitalization Costs?

Electronic Medical Records (EMR) have the potential to decrease medical expenditures by increasing communication between healthcare providers and reducing the incidence of unnecessary tests and medical errors. Using a three-year panel of out-of-home Medicaid spending for long-term care patients in nursing homes, we analyze the effect of nursing home EMR adoption on out-of-home healthcare expenditures for their residents. First, we find evidence that EMR adoption by nursing homes reduces out-of-home healthcare costs for residents by 3.5%-14%. Second, beyond this direct effect, we find a further reduction of hospitalization costs for residents when hospitals and nursing homes both adopt EMR, which is an average savings of 13% of Medicaid expenditure and as much as 35% for hospitals that are part of a system. Given the interdependent nature of healthcare delivery for long-term care patients or patients with chronic conditions, our findings underscore the importance of looking outside the adopting institution when accounting for health IT (HIT) value.

Tracking the impact of nursing informatics

Tracking the impact of nursing informatics

Factors influencing Adoption of Electronic Medical Records in Government Hospitals of Sri Lanka

Electronic medical records (EMR) is a popular topic in the literature with the increasing use of EMR in both developed and developing countries. It supports to achieve health sector goals including but not limited to; improved quality, efficiency, cost reduction and patients’ safety and contributes to the sustainable development goal “ensure healthy lives and wellbeing for all at all ages”. Developing countries like Sri Lanka have a critical requirement of having innovative solutions to improve health outcomes while controlling the cost. EMR identified as a better solution to fulfil this requirement. However, it is questionable whether the rate of adoption is at a satisfactory level compared to the importance and benefits of the EMR. This study aimed at identifying critical success and failure factors in adopting EMR in Sri Lanka and propose strategies for successful adoption. Both primary and secondary data were used for the study. The study focused on experience of forty Government hospitals where the EMR systems established under the Digital Health Project, Sri Lanka. Primary data were collected from the health professionals and the regional project officers of Information and Communication Technology Agency of Sri Lanka who managed and coordinated the EMR implementation process in the hospitals. Focus group discussions (FGD), key informant interviews (KII) were mainly used as data collection tools. Further, the research papers published in peer-reviewed journals were reviewed. During the study, twenty-six factors that influence the success and failure of EMR adoption were identified. These factors were categorized and analyzed under six themes – i.e., human factors, technical factors, organizational factors, financial factors, legal factors and change management factors. The most influential category of factors was human factors. Even though the EMR implementation involves applying technology in the health sector, ‘people’ factor should not be forgotten. Ideally, the future EMR implementations should be based on the lessons learnt and best practices of the previous projects in order to achieve successful adoption and to avoid waste of resources.

Perceived Value of Electronic Medical Records in Community Health Services: A National Cross-Sectional Survey of Primary Care Workers in Mainland China.

Objective: To evaluate the degree to which electronic medical records (EMRs) were used in primary care and the value of EMRs as perceived by primary care workers in China. Methods: A cross-sectional survey was conducted on 2719 physicians (n = 2213) and nurses (n = 506) selected from 462 community health centres across all regions of mainland China except for Tibet. Regional differences in the responses regarding the functionality of existing EMR systems and the perceived value of EMRs were examined using Chi-square tests and ordinal regression analyses. Results: Less than 59% of the community health centres had adopted EMRs. More than 89% of the respondents believed that it was necessary to adopt EMRs in primary care. Of the existing EMR systems, 50% had access to telehealth support for laboratory, imaging or patient consultation services. Only 38.4% captured data that met all task needs and 35.4% supported referral arrangements. “Management of chronic conditions” was voted (66%) as the top preferred feature of EMRs. Higher levels of recognition of the value of EMRs were found in the relatively more developed eastern region compared with their counterparts in other regions. Conclusions: Rapid EMR adoption in primary care is evident in mainland China. The low level of functionality in data acquisition and referral arrangements runs counter to the requirements for “management of chronic conditions”, the most preferred feature of EMRs in primary care. Regional disparities in the realised value of EMRs in primary care deserve policy attention.

Proposed Implementation of Blockchain in British Columbia's Health Care Data Management.

BackgroundThere are several challenges such as information silos and lack of interoperability with the current electronic medical record (EMR) infrastructure in the Canadian health care system. These challenges can be alleviated by implementing a blockchain-based health care data management solution.ObjectiveThis study aims to provide a detailed overview of the current health data management infrastructure in British Columbia for identifying some of the gaps and inefficiencies in the Canadian health care data management system. We explored whether blockchain is a viable option for bridging the existing gaps in EMR solutions in British Columbia’s health care system.MethodsWe constructed the British Columbia health care data infrastructure and health information flow based on publicly available information and in partnership with an industry expert familiar with the health systems information technology network of British Columbia’s Provincial Health Services Authorities. Information flow gaps, inconsistencies, and inefficiencies were the target of our analyses.ResultsWe found that hospitals and clinics have several choices for managing electronic records of health care information, such as different EMR software or cloud-based data management, and that the system development, implementation, and operations for EMRs are carried out by the private sector. As of 2013, EMR adoption in British Columbia was at 80% across all hospitals and the process of entering medical information into EMR systems in British Columbia could have a lag of up to 1 month. During this lag period, disease progression updates are continually written on physical paper charts and not immediately updated in the system, creating a continuous lag period and increasing the probability of errors and disjointed notes. The current major stumbling block for health care data management is interoperability resulting from the use of a wide range of unique information systems by different health care facilities.ConclusionsOur analysis of British Columbia’s health care data management revealed several challenges, including information silos, the potential for medical errors, the general unwillingness of parties within the health care system to trust and share data, and the potential for security breaches and operational issues in the current EMR infrastructure. A blockchain-based solution has the highest potential in solving most of the challenges in managing health care data in British Columbia and other Canadian provinces.

Can Ease of Use and Usefulness perception be influenced by physicians characteristics in the adoption of technology innovations?

Ease of use and Usefulness are the two attributes of Technology Acceptance Model – TAM. These attributes are the basis of this article that comprises the results of a survey with 221 physicians located at Santa Casa de Misericordia de Santos - SCMS, in the state of São Paulo, Brazil regarding the use of an innovation technology tool like Electronic Medical Record. The method was based on a questionnaire specially developed for this study, based on the literature review and the results show that the younger and the newer to the profession, besides those who began to use voluntarily and those who had academic preparation to use this kind of tool showed greater perception of both attributes, what led them to a faster adoption of Electronic Medical Record and its funcionalities like clinical decision support and big data. It was also identified that gender, amount of training and instructors do not influence the perception of attributes leading to adoption, but the familiarity with informatics influence the perception of ease of use as though as professional ties influence the perception of usefullness.

The Impact of Electronic Medical Records on the Process of Care: Alignment with Complexity and Clinical Focus

ABSTRACTAlthough electronic medical records (EMR) have attracted significant academic and practitioner interest, findings regarding the impacts of EMR on hospital performance remain inconclusive. Drawing on organizational information processing theory, we examine whether EMR will improve the process of care to a greater extent when the complexity of hospital operations is higher. In addition, we investigate whether clinical focus complements or substitutes EMR in mitigating hospital complexity. We cluster hospitals into three stages based on their cumulative capabilities as identified by the EMR Adoption Model (EMRAM) and assemble a longitudinal database tracking hospitals’ EMR capabilities and their performance between 2005 and 2014. Our study reveals that advanced stages of EMR mitigate hospital complexity and thus improve the process of care to greater extents than lower stages of EMR. In addition, we find that clinical focus substitutes for lower stages of EMR whereas complements higher stages of EMR in mitigating the potential negative impacts of complexity on the process of care. These findings offer significant managerial implications in aligning EMR capabilities and the clinical focus strategy to mitigate complexity.

Association between Electronic Medical Records and Healthcare Quality

The implementation of electronic medical records (EMRs) has generally been thought to improve medical efficiency and safety, but consistent evidence of improved healthcare quality due to EMRs in population-based studies is lacking. We assessed the relationship between the degree of EMR adoption and patient outcomes.We performed an observational study using discharge data from Tri-service General Hospital from 2013 to 2018. The levels of EMR utilization were divided into no EMRs, partial EMRs and full EMRs. The primary healthcare quality indicators were inpatient mortality, readmission within 14 days, and 48-hour postoperative mortality. We performed a Cox proportional hazards regression analysis to evaluate the relationship between the EMR utilization level and healthcare quality.In total, 262,569 patients were included in this study. Compared with no EMRs, full EMR implementation led to lower inpatient mortality [adjusted hazard ratio (HR) 0.947, 95% confidence interval (CI): 0.897–0.999, P = ..049] and a lower risk of readmission within 14 days (adjusted HR 0.627, 95% CI: 0.577–0.681, P < .001). Full EMR implementation was associated was a lower risk of 48-hour postoperative mortality (adjusted HR 0.372, 95% CI: 0.208–0.665, P = .001) than no EMRs. Partial EMR implementation was associated with a higher risk of readmission within 14 days than no EMRs (HR 1.387, 95% CI: 1.298–1.485, P < .001).Full EMR adoption improves healthcare quality in medical institutions treating severely ill patients. A prospective study is needed to confirm this finding.

Electronic Medical Record and Security Concerns

A number of critical questions remain unanswered in Health-care organizations, which are key to tactical planning, remaining competitive, among other issues that seek for answers from the information technologies spheres. Numerous establishments are evolving to fuse clinical computer unit, which dispense a solitary point of entry for permission to administrative, patient-related and research information. The medical record in a new embodiment lies at the center of developing clinical computer unit: accessible, protected, confidential, acceptable to patients and clinicians; fused with other, non-patient information that are specific. This study presented a review of Electronic Medical Record (EMR), security concerns and security frameworks proposed to improve the security concerns of EMRs. This study was able to provide an insight into the security concerns of EMRs, as well as, the barriers in use and adoption of EMR by health institutions which will bring about improved health services, especially in developing countries where manual record system are still prominent.

Unfolding and Addressing the Issues of Electronic Medical Record Implementation

The social influence and competitive pressure for health technology adoption has increased among developed, developing, and emerging countries. The present study aimed to uncover and address the issues of electronic medical record (EMR) implementation in public sector hospitals in the Kingdom of Saudi Arabia (KSA). It used the social constructivism approach to understand employee attitudes, behaviors, and motivations within the local culture, structure, political forces of the KSA. Data was gathered from 40 participants. These individuals and institutional factors influence the EMR adoption and implementation efforts in public sector hospitals in the KSA. Key EMR implementation issues identified included limited IT skills, low professional qualifications, work-overload, and lack of sufficient planning for the integration of EMR with other systems. The study used a mixture of three theories, institutional, Diffusion of Innovation (DOI), and ability, motivation, and opportunity (AMO), to understand the role of these factors and to propose strategies able to increase the rate of successful EMR implementations in public hospitals in the KSA.

A model to measure self-assessed proficiency in electronic medical records: Validation using maturity survey data from Canadian community-based physicians

ObjectiveAdoption of electronic medical records (EMRs) does not necessarily translate to proficiency –referred to here as EMR maturity. To realize the full benefit of wide scale EMR adoption, the focus must shift from adoption to advancing mature use. This calls for validated assessment models so that researchers, health system planners and digital health developers can better understand what contributes to maturity among physicians. This research aims to validate a measurement model for self-assessed EMR maturity among community-based physicians. MethodsAs part of an Ontario government-funded EMR adoption program, the EMR Maturity Model for community-based practices was adapted from a hospital-based EMR maturity model. A survey instrument was developed on the foundation of the new model and revised by experts and stakeholders. Content validity, face validity and user acceptance were established before survey administration. Internal consistency and construct validity of the model were tested after survey data were collected. Finally, physicians’ comments collected via the survey were qualitatively analyzed to provide additional insights that can be applied to refinement of the model and survey. ResultsAs of August 1, 2019, 1588 physicians completed the survey. Ordinal alpha tests for reliability and content validity yielded an alpha value of 0.86 across all key measures specifically associated with maturity. Among most of these, there was a pattern of weak to moderate significant (p < .0001) positive Spearman inter-correlations. One factor was extracted for items measuring dimensions of maturity and all factor loadings of the key measures were greater than 0.40. The fit of the one-factor model was moderately adequate. This indicates the model is valid and reliable, with consistency across key measures for measuring one factor: maturity. ConclusionsThis is the first known validated model published in English that measures EMR maturity among community-based physicians. While the model is shown to be valid and reliable statistically and qualitative analysis supports this, there is room for improvement. Both the statistical analysis and portions of the qualitative analysis suggest areas of exploration to strengthen the model and survey. Future efforts will include refining the survey to improve user interface and accrue further data, as the sample to date is insufficient for generalizability.

Machine-Learning Implementation in Clinical Anesthesia: Opportunities and Challenges.

Machine-Learning Implementation in Clinical Anesthesia: Opportunities and Challenges.

Electronic medical records and health care promotion in Saudi Arabia.

A few decades ago, the government of Saudi Arabia introduced electronic medical records (EMRs) in some health care facilities. However, the progress in adopting these systems on a national level was slow. In 2008, the Saudi Ministry of Health started an initiative to expand and optimize the use of EMRs in governmental health care institutions. However, some obstacles facing this ambitious plan remain, including negative attitudes of some health care professionals toward EMR systems. Other barriers include poor computer literacy, lack of system customization to hospital needs, and poor support and training from information technology (IT) personnel. Identifying and addressing these barriers is essential for the optimal application of EMR systems in all health care facilities. In this review, the author focused on the benefits of widespread adoption of EMRs in Saudi Arabia, the perceptions of health care professionals, and the challenges and barriers toward improved implementation of this technology.

A Security Framework for Electronic Medical Record

Electronic Medical Record (EMR) is basically the digital equivalent of paper records, or charts at a clinician’s office. EMR assist and make easier the services rendered by a wide range of medical practitioners such as physicians, nurses, pharmacists and many others, hence, increasing the safety of patients. It's importance in the health sector cannot be overemphasized. The designed framework aims at identifying security challenges in the use and adoption of EMR, to design and implement a framework that will address issues identified in the use and adoption of EMR. This study presented a security framework to improve the security and privacy issues of EMRs by adopting Role Based Access Control and RSA cryptography. Role Based Access Control (RBAC) model was used because of its flexibility to support minimal functionality and its simplistic mode of assigning roles and permissions to users. In conclusion, this research was able to improve the security of EMRs and hence will increase its acceptance by health institutions which will bring about improved health services, especially in developing countries were manual record system are still prominent.

The adoption of electronic medical record by physicians: A PRISMA-compliant systematic review.

Background:The electronic medical record (EMR) is considered to be a vital tool of information and communication technology (ICT) to improve the quality of medical care, but the limited adoption of EMR by physicians results in a considerable warning to its successful implementation. The purpose of the present review is to explore and identify the potential barriers perceived by physicians in the adoption of EMR.Methods:The systematic review was carried out based on literature published in 5 databases: PubMed, Web of Science, Scopus, The Cochrane Library, and ProQuest from 2014 to 2018, concerning barriers perceived by physicians to the adoption of EMR.Results:The present study incorporates 26 articles based on their appropriateness out of 1354 for the final analysis. Authors explore 25 barriers that appeared 112 times in the literature for the present review; the top 5 frequently mentioned barriers are privacy and security concerns, high start-up cost, workflow changes, system complexity, lack of reliability, and interoperability.Conclusion:The systematic review explores that physicians deal with different barriers as they intend to adopt EMR. The barriers explored in the present review are the potential to play as references for the implementer of the EMR system. Thus an attentive analysis of the definitive condition is needed before relevant intervention is determined as the implementation of EMR must be considered as a behavioral change in medical practice.