Implementation Of Electronic Medical Record Research Articles

Analysis the readiness of implementing Electronic Medical Records (EMR) at dr. Rasidin Padang Regional Public Health Hospital

Regulation of the Minister Health of the Republic Indonesia No. 24, 2022 concerning EMR states that all health service facilities are required to maintain EMR no later than December 31, 2023. Therefore, dr. Rasidin Padang as a health service facility is also required to carry out EMR. This study aimed to analyze the readiness of implementing EMR at dr. Rasidin Padang. The research was conducted from November to June 2023 using qualitative methods and conducted on 6 informants by purposive sampling. Data were collected through in-depth interviews, observation. The results showed that in terms of organizational culture readiness, there is no timeline for planning activities and policies for the implementation of EMR. In terms of the readiness of human resources, there has been no training related to the implementation of EMR. In terms of computer hardware readiness, the software is still in the stage of perfecting the EMR application. EMR implementation readiness still needs to be improved, such as organizational culture readiness, Human Resources (HR), hardware, and software readiness. Hoped that the hospital will encourage readiness in the transition to electronic medical records with socialization and training that needs to be held immediately considering that EMR must be carried out no later than December 31, 2023.

The impact of limited access to electronic medical records on neurosurgical care within the CARICOM countries: A survey and scoping review

IntroductionGlobal access to electronic medical records (EMRs) continues to grow, however many countries including those within the Caribbean Community (CARICOM) lack access to this system. Minimal research investigating EMR use in this region exists. Research questionHow does limited EMR access impact neurosurgical care within the CARICOM? Materials and methodsThe Cochrane Library, EMBASE, Scopus, PubMed/MEDLINE databases, and grey literature were queried for studies addressing this issue within the CARICOM and low- and/or middle-income countries (LMICs). A comprehensive search for hospitals within the CARICOM was performed and responses to a survey inquiring about neurosurgery availability and EMR access within each facility were recorded. Results26 out of 87 surveys were returned leading to a response rate of 29.0%. Among the survey respondents, 57.7% stated neurosurgery was provided at their facility; however, only 38.4% admitted to using an EMR system. Paper charting was the primary means of record keeping for the majority of the facilities (61.5%). The most frequently reported barriers stalling EMR implementation were financial limitations (73.6%) and poor internet access (26.3%). A total of 14 articles were included in the scoping review. Results from these studies suggest that limited EMR access contributes to suboptimal neurosurgical outcomes within the CARICOM and LMICs. Discussion and conclusionThis paper is the first to address the impact that limited EMR has on neurosurgical outcomes in the CARICOM. The lack of research addressing this issue also highlights the need for ongoing efforts to increase research output focused on EMR accessibility and neurosurgical outcomes in these countries.

Preliminary considerations for electronic medical record (EMR) in the public hospitals of Gandaki province in Nepal

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.
 
 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.
 
 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.

Performance of ICD-10-AM codes for quality improvement monitoring of hospital-acquired pneumonia in a haematology-oncology casemix in Victoria, Australia.

The Australian hospital-acquired complication (HAC) policy was introduced to facilitate negative funding adjustments in Australian hospitals using ICD-10-AM codes. The aim of this study was to determine the positive predictive value (PPV) of the ICD-10-AM codes in the HAC framework to detect hospital-acquired pneumonia in patients with cancer and to describe any change in PPV before and after implementation of an electronic medical record (EMR) at our centre. A retrospective case review of all coded pneumonia episodes at the Peter MacCallum Cancer Centre in Melbourne, Australia spanning two time periods (01 July 2015 to 30 June 2017 [pre-EMR period] and 01 September 2020 to 28 February 2021 [EMR period]) was performed to determine the proportion of events satisfying standardised surveillance definitions. HAC-coded pneumonia occurred in 3.66% (n = 151) of 41,260 separations during the study period. Of the 151 coded pneumonia separations, 27 satisfied consensus surveillance criteria, corresponding to an overall PPV of 0.18 (95% CI: 0.12, 0.25). The PPV was approximately three times higher following EMR implementation (0.34 [95% CI: 0.19, 0.53] versus 0.13 [95% CI: 0.08, 0.21]; p = .013). The current HAC definition is a poor-to-moderate classifier for hospital-acquired pneumonia in patients with cancer and, therefore, may not accurately reflect hospital-level quality improvement. Implementation of an EMR did enhance case detection, and future refinements to administratively coded data in support of robust monitoring frameworks should focus on EMR systems. Although ICD-10-AM data are readily available in Australian healthcare settings, these data are not sufficient for monitoring and reporting of hospital-acquired pneumonia in haematology-oncology patients.

Application of DeLone and McLean Methods to Determine Supporting Factors for the Successful Implementation of Electronic Medical Records at Bali Mandara Eye Hospital

Information technology in the health sector is currently an important factor in providing health services, especially hospitals. Bali Mandara Eye Hospital has implemented information technology in the registration process and bill issuance from 2015. Electronic Medical Record is a new application that will be implemented in 2021 at Bali Mandara Eye Hospital. Electronic Medical Record is a computerized system for recording patient health history. The implementation of electronic medical records at the Bali Mandara Eye Hospital for 1 year has many problems both in terms of regulations, systems and users. Therefore, the DeLone and McLean methods are used to determine the success rate of the implementation of electronic medical records. In this method, research is conducted on 6 variables, namely System Quality, Information Quality, Service Quality, Intention of Use, User Satisfaction and Net Benefits. From each variable, the researcher combines indicators from other researchers that are more appropriate for measuring electronic medical records. The results obtained that all statements submitted are valid. The success rate of electronic medical records at the Bali Mandara Eye Hospital was obtained at 3.22 or 80.50%. To be able to increase this value, it is recommended to improve the Information Quality, System Quality and User Satisfaction

The vision of Dutch paediatric care until the year 2030: prevention and collaboration as key ingredients

Abstract There are many societal developments in The Netherlands that have or will have an impact on Dutch paediatric care. These developments both reveal potential risks in paediatric care and require future improvement of paediatric practices to achieve the best possible outcomes for Dutch children. To realise this, the Dutch Paediatric Society decided in their renewed vision to have a closer focus on prevention and on building partnership with public health, by implementing a building block ‘Interprofessional Collaboration between Paediatricians and Other Health Care Providers’. This building block formulates the wish of the Dutch Paediatric Society to work together in networks with other domains of care, such as public health. Preferably, it will be a flexible network in which the disciplines involved align the needs of the specific child. In order to develop and participate in such a network, pediatricians and public health professionals actively have to invest in connecting, establishing, and further developing professional networks (including patient societies). A first precondition for the development and successful functioning of such a network is the implementation and use of a joint electronic medical record in which all diagnostics, treatment plans and positive health aspects of the child are collected, and which is accessible to all professionals involved. A patient record which guarantees a barrier-free exchange of medical and non-medical information between paediatricians and public health professionals within the framework of the current privacy legislation. A second precondition regards an improvement of the paediatric training curriculum in which the paediatrician of the future will gain knowledge of positive health and integrative medicine. The future paediatrician must be trained to function in networks and to make connections. In this presentation we present an update of the implementation of this building block: what is already realised and how.

Technology Acceptance Model to Implementation of Electronic Medical Record (EMR’s) at Clinic of Rumah Sehat Keluarga Jember

The Rumah Sehat Keluarga Clinic is one of the clinics in Jember that has just implemented electronic medical records (RME) at the end of October 2020. Based on observations made on January 4, 2021, at the Rumah Sehat Keluarga Clinic, it is known that there are several obstacles in implementing the electronic medical record system. outpatient treatment indicating that analysis is necessary. This study aims to analyze the application of outpatient electronic medical records at the Rumah Sehat Keluarga Clinic. Identification of problems using the TAM (Technology Acceptance Model) method by reviewing aspects of external variables, aspects of perceived usefulness, aspects of perceived ease of use, and aspects of behavioral intention to use. This type of research is qualitative with data collection methods, namely interviews, observation, documentation and brainstorming. The subjects of this study are the head of the clinic and the medical record officer. The results showed that based on aspects of external variables, several constraining factors were obtained including the absence of guidelines for using RME for new or old users and there was a diagnosis menu that had not been integrated with the ICD 10 database. Aspects of perceived usefulness, namely the use of electronic medical records in the clinic made the work of the officers faster and more efficient. The perceived ease of use aspect showed that receiving electronic medical records is considered easy to understand, flexible enough with the work of officers and easy to use to help work. Based on the aspect of behavioral intention to use, even though there are several obstacles in its application, outpatients show interest in RME and they will use it in the future. Abstrak: Klinik Rumah Sehat Keluarga baru menerapkan Rekam Medis Elektronik (RME) pada akhir Oktober 2020. Berdasarkan pengamatan terdapat kendala dalam penerapannya yang menunjukkan perlu dilakukan analisis. Tujuan penelitian ini untuk menganalisis penerapan rekam medis elektronik rawat jalan Klinik Rumah Sehat Keluarga. Identifikasi permasalahan menggunakan metode TAM (Technology Acceptance Model) dengan meninjau dari aspek variable luar (external variable), aspek kebermanfaatan (perceived usefulness), aspek kemudahan (perceived ease of use), dan aspek minat (behavioral intention to use). Jenis penelitian ini kualitatif dengan metode pengumpulan data yaitu wawancara, observasi, dokumentasi dan brainstorming. Subjek penelitian ini adalah kepala klinik dan petugas rekam medis. Hasil penelitian menunjukkan bahwa berdasarkan aspek variabel luar (external variable) diperoleh faktor kendala diantaranya tidak adanya panduan penggunaan RME bagi pengguna baru atau lama dan terdapat menu diagnosis yang belum terintegrasi dengan database ICD 10. Aspek kebermanfaatan (perceived usefulness) yaitu penggunaan rekam medis elektronik di klinik membuat pekerjaan petugas menjadi lebih cepat dan efisien. Aspek kemudahan (perceived ease of use) menunjukkan dalam penerimaan rekam medis elektronik dinilai mudah dipahami, cukup fleksibel dengan pekerjaan petugas serta mudah digunakan untuk membantu pekerjaan. Berdasarkan aspek minat (behavioral intention to use) yaitu petugas rawat jalan menunjukkan minatnya terhadap RME serta berencana menggunakannya di masa yang akan datang.

Understanding the Digital Disruption of Health Care: An Ethnographic Study of Real-Time Multidisciplinary Clinical Behavior in a New Digital Hospital.

Understanding electronic medical record (EMR) implementation in digital hospitals has focused on retrospective "work as imagined" experiences of multidisciplinary clinicians, rather than "work as done" behaviors. Our research question was "what is the behavior of multidisciplinary clinicians during the transition to a new digital hospital?" The aim of the study is to: (1) Observe clinical behavior of multidisciplinary clinicians in a new digital hospital using ethnography. (2) Develop a thematic framework of clinical behavior in a new digital hospital. The setting was the go-live of a greenfield 182-bed digital specialist public hospital in Queensland, Australia. Participants were multidisciplinary clinicians (allied health, nursing, medical, and pharmacy). Clinical ethnographic observations were conducted between March and April 2021 (approximately 1 month post-EMR implementation). Observers shadowed clinicians in real-time performing a diverse range of routine clinical activities and recorded any clinical behavior related to interaction with the digital hospital. Data were analyzed in two phases: (1) content analysis using machine learning (Leximancer v4.5); (2) researcher-led interpretation of the text analytics to generate contextual meaning and finalize themes. A total of 55 multidisciplinary clinicians (41.8% allied health, 23.6% nursing, 20% medical, 14.6% pharmacy) were observed across 58 hours and 99 individual patient encounters. Five themes were derived: (1) Workflows for clinical documentation; (2) Navigating a digital hospital; (3) Digital efficiencies; (4) Digital challenges; (5) Patient experience. There was no observed harm attributable to the digital transition. Clinicians primarily used blended digital and paper workflows to achieve clinical goals. The EMR was generally used seamlessly. New digital workflows affected clinical productivity and caused frustration. Digitization enabled multitasking, clinical opportunism, and benefits to patient safety; however, clinicians were hesitant to trust digital information. This study improves our real-time understanding of the digital disruption of health care and can guide clinicians, managers, and health services toward digital transformation strategies based upon "work as done."

The Effect of Transactional Leadership Style of the Head of Emergency Room, Teamwork and Work Environment on The Compliance Level of Health Worker in the Use of Electronic Medical Record with Motivation as an Intervening Variable at Tarakan Hospital

Document management using a computer-based system in the health sector which is becoming a global trend is the Electronic Medical Record (EMR). EMR is a sub-system of health information that has begun to be widely applied in Indonesia. Based on the results of data from the Tarakan Hospital, only 24% of EMR usage was found in July 2021 in the Emergency Room. This study aims to analyze the effect of the transactional leadership style of the head of the emergency department, teamwork and work environment on the level of compliance of health workers in implementing EMR with motivation as an intervening variable in Tarakan Hospital. This study is a cross-sectional study with a quantitative causality approach. By using purposive sampling technique, as many as 100 health workers were sampled in this study. Statistical tests were performed using frequency distribution and path analysis. Most (60%) of the subjects were >30 years old, most (59%) had an undergraduate education level, and most (62%) had worked >5 years. The results of the analysis in this study indicate that the transactional leadership style of the ER head, teamwork, work environment, affects the level of compliance of health workers in implementing EMR with motivation as an intervening variable in the ER at Tarakan Hospital. Therefore, support is needed in the implementation of EMR with the right standard operating procedures so that it can be carried out and developed to the maximum.

Improving the Quality of Electronic Medical Record Documentation: Development of a Compliance and Quality Program.

Introducing an electronic medical record (EMR) system into a complex health care environment fundamentally changes clinical workflows and documentation processes and, hence, has implications for patient safety. After a multisite "big-bang" EMR implementation across our large public health care organization, a quality improvement program was developed and implemented to monitor clinician adoption, documentation quality, and compliance with workflows to support high-quality patient care. Our objective was to report the development of an iterative quality improvement program for nursing, midwifery, and medical EMR documentation. The Model for Improvement quality improvement framework guided cycles of "Plan, Do, Study, Act." Steps included design, pre- and pilot testing of an audit tool to reflect expected practices for EMR documentation that examined quality and completeness of documentation 1-year post-EMR implementation. Analysis of initial audit results was then performed to (1) provide a baseline to benchmark comparison of ongoing improvement and (2) develop targeted intervention activities to address identified gaps. Analysis of 1,349 EMR record audits as a baseline for the first cycle of EMR quality improvement revealed five out of nine nursing and midwifery documentation components, and four out of ten medical documentation components' completion and quality were classified as good (>80%). Outputs from this work also included a framework for strategies to improve EMR documentation quality, as well as an EMR data dashboard to monitor compliance. This work provides the foundation for the development of quality monitoring frameworks to inform both clinician and EMR optimization interventions using audits and feedback. Discipline-specific differences in performance can inform targeted interventions to maximize the effective use of resources and support longitudinal monitoring of EMR documentation and workflows. Future work will include repeat EMR auditing.

The role of electronic medical records in improving health care quality: A quasi-experimental study.

The Teleprimary Care—Oral Health Clinical Information System (TPC-OHCIS) is an updated electronic medical record (EMR) that has been applied in Malaysian primary healthcare. Recognizing the level of patient satisfaction following EMR implementation is crucial for assessing the performance of health care services. Hence, the main objective of this study was to compare the level of patient satisfaction between EMR-based clinics and paper-based clinics.The study was a quasi-experimental design that used a control group and was conducted among patients in 14 public primary healthcare facilities in the Seremban district of Malaysia from May 10, to June 30, 2021. Patient satisfaction was assessed using the validated Short-Form Patient Satisfaction Questionnaire, which consisted of 7 subscales. All data were analyzed using the IBM Statistical Package for Social Sciences version 21.A total of 321 patients consented to participate in this study, and 48.9% of them were from EMR clinics. The mean score for the communication subscale was the highest at 4.08 and 3.96 at EMR-adopted clinics and paper-based record clinics. There were significant differences in general satisfaction and communication subscales, with higher patient satisfaction found in clinics using EMR.With the utilization of EMR, patient satisfaction and communication in delivering healthcare services have improved.

Nurses' Experiences After Implementation of an Organization-Wide Electronic Medical Record: Qualitative Descriptive Study.

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.

Normalisation of electronic medical records in routine healthcare work amidst ongoing digitalisation of the Philippine health system

By drawing perspectives from the multi-level perspectives in sociotechnical transition and the normalisation process theory, this article explores how ongoing (i.e., incomplete) national level reforms in health information management (HIM) shape the normalisation of electronic medical records (EMRs) in Philippine rural health work. Based on document review, interviews, and observations, we argue that an ongoing HIM regime transition—transitioning from paper-based to an electronic HIM regime—may exert ambivalent institutional pressures on health workers through their institutions’ implementation context. The ambivalence of the implementation context—one that accommodates both EMR and paper-based medical records—offers conflicting social, cognitive, and material resources for normalising EMRs. In such a context, we find that health workers performed selective participation and partial implementation in normalising EMRs in their routine healthcare work. In selective participation, select health workers—often, the technologically savvy—could actively participate in the EMR implementation while others focused on their clinical work. At the same time, since only a few could use the EMR in routine work, EMRs were implemented partially in particular instances where it is deemed more valuable and applicable. We emphasised in this article how complementing the idea of normalisation with sociotechnical transition may reveal the emergence of pressures from various institutions and stakeholders that advances (or impede) the normalisation of healthcare innovations.

EMR adoption in Dhaka, Bangladesh: a template to index pediatric central nervous system tumor care and a review of preliminary neuro-oncologic observations.

PurposeTo describe the design, implementation, and adoption of a simplified electronic medical record (EMR) and its use in documenting pediatric central nervous system (CNS) tumors at a tertiary care referral hospital in South-East Asia.MethodsA novel EMR, cataloguing pediatric CNS tumors was used to collect data from August 2017 to March 2020 at National Institute of Neurosciences and Hospital (NINS&H) in Dhaka, Bangladesh.ResultsTwo hundred forty-nine pediatric patients with a CNS tumor were admitted to NINS&H. Fifty-eight percent of patients were male, and the median age was 8 years. A total of 188/249 patients (76%) underwent surgery during their index admission. Radiographic locations were known for 212/249 (85%) of cases; the most common radiographic locations were infratentorial (81/212; 38%), suprasellar (45/212; 21%), and supratentorial (29/212; 14%). A histopathological classification was reported on 156/249 (63%) of patients’ cytology. The most common infratentorial pathologies were medulloblastoma (22/47; 47%) and pilocytic astrocytoma (14/47; 30%). The median time between admission and surgery was 36 days, while the median post-operation stay was 19.5 days.ConclusionsThe feasibility of a basic EMR platform for a busy pediatric neurosurgery department in a lower-middle income country is demonstrated, and preliminary clinical data is reviewed. A wide variety of pediatric CNS tumors were observed, spanning the spectrum of anatomic locations and histopathologic subtypes. Surgical intervention was performed for the majority of patients. Barriers to care include limited molecular diagnostics and unavailable data on adjuvant therapy. Future targets include improvement of clinical documentation in the pre-operative and post-operative period.

Impact of electronic medical records and COVID-19 on adult Goals-of-Care document completion and revision in hospitalised general medicine patients.

ABSTRACTBackgroundConversion from paper‐based to electronic medical records (EMR) may affect the quality and timeliness of the completion of Goals‐of‐Care (GOC) documents during hospital admissions and this may have been further impacted by the COVID‐19 pandemic.AimsTo determine the impact of EMR and COVID‐19 on the proper completion of GOC forms and the factors associated with inpatient changes in GOC.MethodsWe conducted a cross‐sectional study of adult general medicine admissions (August 2018–September 2020) at Dandenong Hospital (Victoria, Australia). We used interrupted time series to model the changes in the rates of proper GOC completion (adequate documented discussion, completed ≤2 days) after the introduction of EMR and the arrival of COVID‐19.ResultsWe included a total of 5147 patients. The pre‐EMR GOC proper completion rate was 27.7% (overall completion, 86.5%). There was a decrease in the proper completion rate by 2.21% per month (95% confidence interval (CI): −2.83 to −1.58) after EMR implementation despite an increase in overall completion rates (91.2%). The main reason for the negative trend was a decline in adequate documentation despite improvements in timeliness. COVID‐19 arrival saw a reversal of this negative trend, with proper completion rates increasing by 2.25% per month (95% CI: 1.35 to 3.15) compared with the EMR period, but also resulted in a higher proportion of GOC changes within 2 days of admission.ConclusionsEMR improved the timeliness and overall completion rates of GOC at the cost of a lower quality of documented discussion. COVID‐19 reversed the negative trend in proper GOC completion but increased the number of early revisions.

Change in nurses’ psychosocial characteristics pre- and post-electronic medical record system implementation coinciding with the SARS-CoV-2 pandemic: pre- and post-cross-sectional surveys

BackgroundThe impacts of electronic medical record implementation on nurses, the largest healthcare workforce, have not been comprehensively examined. Negative impacts on nurses have implications for quality of patient care delivery and workforce retention. ObjectiveTo investigate changes in nurses’ well-being, intention to stay, burnout, work engagement, satisfaction, motivation and experience using technology pre- and post-implementation of an organisation-wide electronic medical record in Victoria, Australia. MethodsThe natural experiment comprised an electronic medical record system implementation across six hospitals of a large tertiary healthcare organisation. Cross-sectional surveys were collected pre-electronic medical record implementation prior to the SARS-CoV-2 pandemic in 2019, and 18-months post-electronic medical record implementation during the pandemic in 2020, and findings compared. ResultsA total of 942 surveys were analysed (550 pre-electronic medical record (response rate 15.52%) and 392 post-electronic medical record (response rate 9.50%)). Post-electronic medical record, nurses’ work satisfaction (r = 0.23, p=<0.001), intention to stay (r = 0.11, p = 0.001) and well-being (r = 0.17, p=<0.001) decreased. Nurses’ perceived competence increased (r = 0.10, p = 0.002) despite decreased autonomy (r = 0.10, p = 0.003). Two of three dimensions of work engagement worsened (vigour r = 0.13, p=<0.001; dedication r = 0.13, p=<0.001) and all dimensions of burnout increased (exhaustion r = 0.08, p = 0.012, cynicism r = 0.07, p = 0.04 and reduced efficiency r = 0.32, p=<0.001). Nurses reported more burnout symptoms (95% CI 4.6–4.7%, p = 0.036), were less engaged (95% CI 49.6–49.9%, p=<0.001) and career trajectory satisfaction decreased (r = 0.15, p=<0.001). Matched data from 52 nurses showed changes in the same direction for all items except career trajectory satisfaction, hence validated findings from the larger unmatched sample. ConclusionsImplementation of an electronic medical record immediately followed by the SARS-CoV-2 pandemic was associated with negative changes in nurses’ well-being, intention to stay, burnout, work engagement and satisfaction.

Electronic medical record implementation in a large healthcare system from a leadership perspective

BackgroundInformation on the use of change management models to guide electronic medical records (EMR) implementation is limited. This case study describes the leadership aspects of a large-scale EMR implementation using Kotter’s change management model.MethodsThis case study presents the experience in implementing a new EMR system from the leadership perspective at King Abdulaziz Medical City, a large tertiary care hospital in Riyadh, Kingdom of Saudi Arabia. We described the process of implementation and outlined the challenges and opportunities, throughout the journey from the pre-implementation to the post-implementation phases.ResultsWe described the corresponding actions to the eight domains of Kotter’s change management model: creating a sense of urgency, building the guiding team, developing a change vision and strategy, understanding and buy-in, removing obstacles, creating short-term wins, building on the change and anchoring the changes in corporate culture.ConclusionsThe case study highlights that EMR implementation is not a pure information technology project but rather is a technical-based complex social adaptive project that requires a specific set of leadership competencies that are central to its success. It demonstrates that change management models might be useful for large-scale EMR implementation.

Rekam Medis Elektronik sebagai Pendukung Manajemen Pelayanan Pasien di RS Universitas Gadjah Mada

Electronic Medical Records (EMR) is a digital repository of administrative and medical data to support integrated health services. EMR can be used to support case management activities such as identification, care coordination, patient progress monitoring, and provide cost-effective interventions. One of main factor in information system implementation is users. Based on users’ perceptions, recommendations can be made. It’s used to maximize the adoption and development of EMR. The purpose of this study to explore the users’ perceived benefits of EMR implementation to support case management. This research is a qualitative research with a case study design. Informants were EMR users, namely doctors, nurse, pharmacist, medical record officer, and laboratory assistant. They were selected through purposive sampling technique. We conducted face-to-face semi-structured interviews and observation. This research used an interview guide with open-ended questions and an observation guide. Results showed benefits of EMR were support patient safety, reduce duplicate examinations, continuity of care, patient care efficiency, and collaboration among health professionals. It is suggested to develop a patient reminder feature and periodic staff training.

Performance, Barriers, and Satisfaction of Healthcare Workers Toward Electronic Medical Records in Saudi Arabia: A National Multicenter Study.

BackgroundElectronic medical record (EMR) systems are nowadays available internationally, including in Saudi Arabia. Nevertheless, there are still many obstacles to overcome before their effective implementation. This cross-national study aimed to investigate the perceptions and practices of healthcare workers toward implemented EMR systems.MethodsA cross-sectional study was conducted across selected hospitals in the four cities of Al-Ahsa, Dammam, Medina, and Riyadh in Saudi Arabia. Healthcare workers of all specialties were invited to participate in the study during the six-month study period from August 2019 to February 2020. The questionnaire was submitted online through institutional e-mails.ResultsThe study included a total of 2684 healthcare providers. Almost half of the respondents (47.1%) were aged between 35 and 50 years. High experience with computer use was observed among 38.3% of them, while 54.3% attended EMR training activities. The performance scores of EMR’s compared to previous routines had a median of 24 (interquartile range {IQR} = 0-38). The satisfaction scores with EMR’s ranged between 16 and 80 with a median of 53 (IQR = 48-61). Older participants (>50 years), non-Saudis, and those who attended EMR training had statistically significant higher scores of both EMR performance and EMR satisfaction, (p<0.001). Those working in other medical specialties (not major) had statistically significant higher scores of EMR performance alone (p<0.001), while general practitioners (p<0.001) and females (p = 0.001) had statistically significant higher scores of EMR satisfaction alone. EMR systems’ positive impact on quality of care was the highest agreed-upon benefit reported, while the temporary loss of access to patient records if computers crashed or power failed was the highest agreed-upon barrier.ConclusionsThe attitude and satisfaction of healthcare workers in Saudi Arabia towards EMR systems are acceptable particularly among those who are older, non-Saudi, and have attended EMR training. Improved quality of care was the main noted benefit of EMR’s, followed by improved productivity. The temporary loss of access to patient records if computers crashed or power failed, followed by privacy and security concerns, was the major EMR barrier mentioned.

Effect of Electronic Medical Record Quality on Nurses' Perceived Usefulness and Ease of Use.

Electronic medical records have been adopted in Korean clinical settings for a few decades. However, there is a lack of studies on the quality, usefulness, and easy use of electronic medical records examined from the perspective of nurses. This study sought the effect of the system quality, information quality, and service quality of an electronic medical record on nurses' perceived usefulness and ease of use of the electronic medical record. A total of 278 nurses from four hospitals completed a self-administered questionnaire using a 5-point Likert scale. The data were analyzed using descriptive statistics and hierarchical multiple regression methods. The results showed that the system, information, and service quality of the electronic medical records explained 36.2% of the variance in perceived usefulness ( F = 51.760, P < .001) and 43.4% of the variance in perceived ease of use ( F = 70.019, P < .001). Thus, these three qualities were significant factors predicting perceived usefulness and ease of use. The close cooperation of stakeholders including administrators, healthcare providers including nurses, and researchers involved in clinical practice will improve electronic medical record quality leading to user-friendly electronic medical record implementation. This study provided statistical interpretations to help in understanding regression analysis.