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'electronic aesculapian disks Essay Cynthia J sensations imposing Canyon University: HCA 450 November 11, 2012 electronic aesculapian examination checkup examination Records Essay well(p)ness check state up covering has change in the expire couple of decades. In the past endurings discs were kept in a file on root word fetching up excessive room. In the past, report charts were the b atomic number 18ly means of keeping a persevering’s aesculapian diagnoses documented. to a greater extent(prenominal) or less(prenominal) of these charts atomic number 18 belt up employ today in wellness sell facilities, however they atomic number 18 slackly creation replaced with a much(prenominal) boot out method; electronic medical move intos (EMR’s).This virtual entropy†cultivation c cypher plunder serve as a vehicle to promote and to disseminate similar info definitions and trump practices to providers, consumers, and rough others avo cati nonp arild in shade mendment efforts nation entirely(prenominal) toldy and inter matterly (Varkey, 2010). The electronic aesculapian Records is an coming calculating workizes medical record establishment that hand overs medical selective teaching for medico’s office and infirmarys at heart a matter of seconds while offering look at. This organization in allows the wellnessc be supply and mendeleviums to modified, store and retrieves enduring’s medical records.electronic medical records argon legible and calculated. The Electronic checkup Record (EMR) has been whatsoever since the late 1960‘s, when Larry scum bag introduced the opinion of the Problem Oriented Medical Record into medical practice (NASBHC, 2012). Weeds innovation introduces the concept of the Problem Oriented Medical Record into the medical practice, which verifies the diagnosing (NASBHC, 2012). However, it wasn’t until 1972 when the Regenstreif Institute g enuine the setoff-class honours degree medical records constitution. Although it was a great invention, physicians didn’t try on to implement it right a fashion.This impudent dust would assistant physicians improve patients conduct. Although, $19 billion in stimulant funds e trulyplacehear been invested into the Electronic wellness record (EHRs) a nonher signalize for EMRs; the Obama administration tallly suggested that health c atomic number 18 and hospitals facilities start to digitize patient data and start making better design of the advance applied science(Greenemeier, 2010). The health palm industry has been slow to correct to this new constitution. Although the EMR g overning body is intended to make patients records more glide slopeible for the physicians and supply, still many choose non mechanismed it yet.Given the lack of EMR adoption throughout the health pity industry, less than 10 percent of U. S. hospitals digest adopted electronic medical records. Cost is the un both(prenominal)eratic reason many recognize resisted or argon un giveing to adopt the EMR transcription and shortage on staff as well. In a modern interview on November 9, Jessica in human election at Vineville Internal Medicine, with Dr. Mary Bell Vaughn presiding as the physician over the practice. The practice has been dumb groundment electronic medical records systems since the practice open in 2002. Dr.Vaughn mentation patients and staff call for easy entryway to their records when quested. Some of her other reasons atomic number 18 as follow: • composingless, less(prenominal) transshipment center • No physician running around ( Patient info available at feel tips) • Saves date spent with patient • Good for introduce protestation • Financial Good This system is meshing base and procedures an E-Clinical programme through a portal. This system identicalwise allows prescriptions to be send to the local do drugsstore as well. Blood reckon directs argon also put into the patients charts as well.Recently, the practice took on new patients with news theme charts, because their physician retired. In this cause their near recent charts were born-again over to EMRs. However those newspaper publisher charts still exist in a tiny storage area if further study is needed on the patient. though the practice implements the EMRs system from the rattling beginning, the physician and staff are very laughing(prenominal) with the system. closely patient entropy is put into the system via calculating machine on the spot while the patient is telling the nurse or physician what is ail them.Although thither system is a web based system, it has devil backup systems in ii contrary locations just in case the systems go mastered or power outage. The EMR system has had great bore impact on the practice. The patients care has been improve by the system. It allows the physicia n to track and tellingly treat the patient. In some cases if the patient is located at a nonher(prenominal) health care facility this system allows them to send info to multiply pot for care, no matter whither they are. Dr.Vaughn’s practice is already looking into the future to implement s shutd stimulate out text message to patients to inform them of appointments. Patients have access to their care any measure. EMR adoption is slow to be implement into some practices. Although thither is some disapproval of the electronic medical records today, it is merely a digitized version of paper chart. This system will slash medical errors and help put selective tuition in front of researchers This new form of engineering science is here to stay and the so 1r health care facilities start utilize it the more efficient results they will receive.References Prathibha Varkey (2010). Medical feature guidance, Sudbury, Massachusetts: J anes and Bartlett Publishers. History of th e Electronic Medical Record system (2012) Retrieved November 8, 2012 www. nasbhc. org Will Electronic Medical Records Improve Health Care? (2009) Retrieved November 8 2012 http://www. scientificameri quite a little. com/article. cfm? id=electronic-health-records\r\nElectronic Medical Records\r\nEngineering steering Field stand out Electronic Medical Records: A Case sphere to Improve Patient Safety at olympian capital of Seychelles Teaching hospital By Annie Bittaye dance Semester, 2009 An EMGT Field Project report submitted to the Engineering Management Program and the Faculty of the Graduate School of The University ofK. ansas in partial fulfillment of the emergencys for the degree of Masters of Science )= • , , tom turkey Bowlin Cotntnittee Member ‘~k Committee Member run into original: _ _&-4â€_:”/~,,,,,,”1_-. -Q:;,,.. r5c—-_ _ slacken of ContentsTable of Contents ………………………†¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦. 2 distinguish of Figures ……………………………………………………………………………………………………… 3 leaning of Tables ………………………………………………………………….. ………………………………….. 3 Ac hit the sackledgments……………………………………………………………………â₠¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦ Executive epitome ……………………………………………………………………………………………… 5 1. 1. 1. 2. 3. 3. 1. 3. 2. 3. 3. 3. 4. 4. 4. 1. 4. 2. 5. 6. 7. Introduction…………………………………………………………………………………………………… 6 Background of gallant capital of Seychelles Teaching Hospital …………………………………………… 7 belles-lettres Review …………………………………†¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦ 0 operation and Methodology ………………………………………………………………………….. 17 data-based Design …………………………………………………………………………………. 17 Survey Procedure ……………………………………………………………………………………… 18 selective information Analysis ……………………………………â⠂¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦ 9 Limitations of the try out …………………………………………………………………………….. 19 Results………………………………………………………………………………………………………… 20 Reasons wherefore EMR is non being apply at RVTH …………………………………………….. 23 Benefits and challenges of EMR…………………………………………â⠂¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦Ã¢â‚¬Â¦. 24 synopsis…………………………………………………………………………………………………….. 0 Conclusion ………………………………………………………………………………………………….. 30 Suggestions for Additional bring in …………………………………………………………………… 32 References ……………………………………………………â €¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦. 34 Glossary ……………………………………………………………………………………………………………. 5 vermiform appendix …………………………………………………………………………………………………………… 36 2 List of Figures Figure 1: Sources of funding, RVTH 2008 …………………………………………………………….. 22 Figure 2: Averages ofEMR functions in distinguish of relevance to work at RVTH …………… 29 List of Tables Table 1: chassis of patients dealn at RVTH in 2008 ………………………………………………….. 7 Table 2: List of Professionals, RVTH 2009 ……………………………………………………………. 0 Table 3: Computer throwership and former computer training received by the respondents at RVTH ………………………………………………………………………………………….. 28 Acknowledgments My journey towards my Masters degree was a spacious and fruitful unmatchable. The Engineering Management (EMGT) program has not just exposed me to much information and heads barely also opened a appearance towards my charge path. Thank you to my parents, Ebrima and Lucy who have eer been a source of great inspiration and strength to me. They taught me the value ofeducation and their prayers has forever been with me. give thanks to my brother, Baboucar who encouraged me to pursue my Masters degree and the never ending affirm I receive from him. Special thank to my six course of instruction old son, Ebrima for his understanding that Im at school when Im not home to read him a bed fourth dimension story. I also want to thank all my EMGT instructors in particular Professor Herb Tuttle, Dr Tom Bowlin and spear Dick who worked with me recently, for the wonderful information and feedback they provided on this project. Thanks to Parveen Mozaffar for her extreme die hard and encouragement during the course of my studies.Thanks to the staff at royal Victoria Teaching hospital for providing me with all the needed information for this project. Last plainly not least, my gratitude goes out to Dr Don Anthony Woods. It is because of his influence that brought me where I am today. He always had my best interest at heart and I want to thank him for that. May God bless you! Executive drumhead Most countries in Europe and the USA are increasingly using an electronic medical record (EMR) system to help improve healthcare tone. Unfortunately, The Gambia government activity activity faces a series of health crises including nevertheless not particular to human immunodeficiency virusIAIDS, malaria, diabetes and tuberculosis.These disorders threaten the lives of thousands of peck. escape of infrastructure and trained, see staff are considered important barriers to scaling up discourse for these diseases. The contri andion of this field proj ect outlines the benefits of an EMR system at majestic Victoria Teaching Hospital (RVTH) and how it will improve patient golosh. This is a descriptive understand using interview perplexitynaires from officials at the Royal Victoria Teaching Hospital. The study also looks into other facilities in similar developing countries with advanced systems, exclusively not so advanced as to be at the train of state-of-the­ art facilities in the U.S. Results from this study forecasts the immenseness of an EMR system at RVTH to facilitate effective and efficient data foregatherion, data entry, information retrieval and report generation. As a catalyst for ripening, the executing of an EMR system at RVTH whitethorn make it one on the best hospitals in the West Afri drop region. 5 1. Introduction According to Dick and Steen, Electronic Medical Record (EMR) is the compilation of patient medical information in a computer-based format that allows the collection, storage, retrieval, and discourse of this data.An electronic medical record replicates a paper chart and contains both clinical information (diagnoses, allergies, drug resistance and preachings) and demographic information just active a patient; it provides a nationwide medical draw and commode be employ by clinicians as a tool to determine appropriate treatment for patients. EMR is not only being welcomed by healthcare providers as a way to improve care delivery merely also serves as a catalyst and gold standard for development (porter, Kohane, & Goldman; Reifsteck, Swanson, & Dallas).Unfortunately, Africa, a continent faced with many challenges ranging from epidemics, civil wars, and disasters, lacks proficient-bodied healthcare infrastructure in the form of computerized health care systems. For instance, Ghana has one the best health bases in the region, Korle-Bu Teaching Hospital. This Hospital, for example, is currently the only institution in the West Afri rear sub-region which performs surgery. Due to the tone of voice of outcome, it now receives referrals from intimately parts of the continent namely the Gambia , Sierra Leone, Liberia, Togo Benin, Tanzania, Nigeria, Cameroon, Cote d Ivoire, and Ethiopia.Despite its exemplary performance, the hospital has no computerized information system which sess help improve care delivery in the region. therefore, the purpose of this study is to break down the potential benefits of EMR and its net part to up healthcare delivery development in less real countries give care The Gambia. 6 1. 1. Background of Royal Victoria Teaching Hospital The Gambia is a small rural in West Africa, with a population of more or less 1. 5 million. RVTH has been in existence for over degree Celsius years in The Gambias capital, Banjul.It utilise to be called Royal Victoria Hospital until in the late 1990s, when its name was changed to RVTH. The Gambian Government square upd that it had to subjugate its dependence on foreign reanimates by establishing a medical school in the University of The Gambia (UTG). The UTG now uses RVTH to teach its clinical students. In recent years, The Gambia has been doing much on its own initiative to fruit to improve the healthcare of the nation. There are 540 beds in the hospital and the two largest Departments are Pediatrics and Maternity.The biggest â€Å"killer” disease in The Gambia is malaria, with late children and pregnant women being particularly vulnerable to this disease. Diabetes, high blood pressure, pneumonia and eye problems much(prenominal) as trachoma and cataracts are also major health problems. The following slacken provides an estimation of how many patients were seen at RVTH in the year 2008. Procedure Inpatient Admissions Children admitted to Pediatrics Patients treated in the Eye Center Out-Patient Appointments Out-Patients in the ER Number of Patients 25,281 9,352 986 over 184,365 24,334 Table 1: Number of patients seen at RVTH in 2008 7Unfortunately, RVTH does not have any EMR system in place to facilitate patient recourse. As noted by participants, â€Å"EMR software i s not used at RVTH because administration keeps complaining of money. It looks high-priced to them and also they are more used to the paper leaflet”. Currently, information is very fragmented and therefore does very little to help patient safety and soundbox in care. another(prenominal) important issue here is that a large number of these patients are illiterates. To crack they receive the appropriate treatment, they will have to explain to the physician current medications they are taking etc.This git be a very thought-provoking and deadly to the patient sometimes. The typical paper medical record contains sections including information on demographics, admissions, discharge summaries, progress notes, protocols, testing ground results, radiology results, surgical and pathology reports, orders for, treatment and nursing notes. Most documentation regarding treatment of a patient is scripted directly in the patients medical chart. On a minded(p) day a patient arrives a t the hospital for care, sign in his name and fronts anyplace from 30 minutes to six hours o buzz off their records pulled depending on the day. Physicians, nurses, medical residents who need access the information in the medical record mustinessiness(prenominal) wait till its available. Typically, medical records are transported to the outpatient clinic where the patient would be seen, and then perished to storage center to be filed again. It is requirement for the medical record to follow the patient throughout their visit. If the patient was seen in one clinic where orders were written, it was necessary to physically transport the record when the patient moved to the medicament room for treatment. The purpose of this field project is to test the potential benefits of an EMR system and its ultimate contribution to up(p) patient safety at the Royal Victoria Teaching Hospital in The Gambia. 9 2. books Review The first generation of EMRs was extensions of medical armorial bearing systems in large US hospitals. Over the suffer four decades, they have been used as tools to organize and store medical data. EMRs are widely swallow uped as important tools to pay high quality health care in the US, Europe and other authentic countries.Evidence shows that using EMRs that embroil decision encourage systems improves quality of care and both reduce medical errors and unnecessary medical investigations (Partners in Health), defecate wind with the use of EMRs in developing countries, if available, is much more limited than it is in the US and Europe. Now there is extensive interest in using medical information systems to support the treatment of HIV and TB in Africa, Latin America, and Asia. In most African countries, healthcare information systems have been driven mainly by the need to report aggregate statistics for government or funding agencies.Such data collection can be performed with simple paper forms at the clinic level, with all electronic dat a entry done centrally, but that admittance tends to be difficult and time­ consuming and whitethorn provide little or no feedback to the staff collecting data. Individual patient data that are collected and accessible at the point of care can support clinical do itment. Clinicians can advantageously access previous records, and simple tools can be incorporated to warn of potential problems much(prenominal) as incompatible drugs.Physicians or nurses can check on the outcomes of individuals or groups of patients and perform research studies. Many of these functions will work well on paper or with simple spreadsheets for up to 100 patients but stimulate very time-consuming and potentially unreliable with more than 1,000 records, and virtually impossible with 10,000 or more. 10 Experience with the use ofEMRs in developing countries is much more limited than it is in the US and Europe, but there is now considerable interest in using medical information systems to support the tre atment of HIV and TB in Africa.Some examples of EMR use in Africa hold: • The Regenstrief Institute in collaboration with Moi University in Kenya developed an EMR for general patient visits to clinics in western Kenya. This system was subsequently modified to support the care of some(prenominal) thousand HIV patients. • Baobab Health alliance in Malawi has developed an EMR system using innovative, low-power touch-screen PCs for data entry and display. This system is now used to support the care of more than 7,000 HIV patients in the lighthouse clinic in Lilongwe and has been chosen by the national HIV program for use throughout the country. [email&# one hundred sixty; comforted], an HIV medical information system developed for US patients, has now been deployed in Uganda and is planned for use in other African countries and in Latin America. (Partners In Health) A wide-ranging literature reassessment of electronic medical record execution over the past decade reveals that clinical, workflow, administrative, and revenue enhancement benefits of the EMR surpass barriers and challenges. Among other key efforts, organizations must train and propel users to navigate EMR systems, as well as develop a common structured language.Clinicians who used CPRs arrange that electronic 11 access to clinical infonnation saves time and provides a thorough and efficient way to manage patient information To reap the full benefits of an EMR, organizations must redesign current workflows and practices to evolve into efficient providers of care. EMR systems are developed to meet the following goals: improve quality of care, reduce organizational get down, and produce a data stream for electronic billing. (Dassenko and Slowinski).The EMR meets these goals through workflow automation, connectivity, and data mining. (Gaillour) The Computer-based Patient Record Institutes (CPRI) definition concurred with the other researchers, but added that the EMR provides protection of patient and provider mysticity, has a define vocabulary and standardized coding, produces documentation as a by-product of patient care, connects local and remote systems and provides electronic support for secondary users (payers, policymakers, researchers). Fromberg and Arnatayakul) Unfortunately, most EMR systems are uneffective to offer all of the components defined by the CPRI because ”the engineering science is too complex and too expensive, determines wont use computers, and standards dont exist. â€Å"(Gaillour) The advantages associated with implementing EMRs are well documented and are straightforward. The difficulty comes with placing a dollar figure to these advantages; consequently, hardly a(prenominal) organizations have print studies describing the actual approach and benefits attained from implementing EMRs. Bingham) The benefits associated with CPRs are organise into four categories: clinical, workflow, administrative, and revenue enhancement. Re nner, states that measuring all the benefits associated with EMRs is 12 virtually impossible, and that it is plausibly safe to select those that can make the greatest financial difference, and incorporate them into a financial model.Clinical benefits seen after implementing an EMR entangle: better access to the chart, alter clinical decision making and disease management, enhanced documentation, simplified patient education, and increased bare(a) time to spend with patients, accompanied by improved perception of care and quality of work life. These benefits eventually result in better delivery ofpatient care and safety. Despite all of these benefits, EMRs are not a standard in todays healthcare systems. It is evident that EMR technology is still a hot topic for intelligence when browsing through current healthcare technology and management journals.The following barriers have kept healthcare leaders discussing EMR technology instead of adopting it: follow, leadership, ROI, ve ndors keeping up with users needs, and deficits in the following categories: public policy, standards, tribute, and a straightforward definition. First of all, cost has kept organizations from implementing EMR systems. These costs can be organized into the following categories: software, hardware, infrastructure development and maintenance, implementation, education, planning, and administration.Software costs embroil development or purchase, maintenance, and upgrades over time, while hardware costs include purchase of workstations. (Mohr) Infrastructure development and maintenance costs include servers, interfaces, workstations, network cables, network maintenance, and help desk operations. Planning costs include development of an implementation plan, identifying measurable outcomes, and choosing important metrics and goals, while implementation costs include training, overtime 13 ssociated with entering patient data, course disruption during transition, employee resistance t o change, and lost productivity. Drazen, suggested that leadership was probably a more significant barrier than cost because, in the past, healthcare leaders have elevated capital for essential business initiatives such as major building programs, acquiring a physician network, or starting up a managed care organization. This amount of capital is on the same overcome as an EMR. Next, Drazen tell that a lack of government support is a major issue safekeeping up EMR implementation.Unfortunately, the federal government does not provide fmancially to EMR implementation projects. Without standards and structured data definitions, computer systems are not guaranteed to interface easily with each other, and databases are not easily developed. Most individual departments in spite of appearance a healthcare system have already invested in computerized patient information systems; however, these systems are stray and do not communicate well with one some other. Getting these systems t o interface is one challenge veneering EMRs. Data surety continues to be an ongoing challenge.Bergman, appoint that politicians, consumer advocates, and the general public have voiced hits about risks to the privacy and confidentiality of patient information. However, when compared with the security of the paper chart, the EMRs electronic audit trails and pass actors line actually improves internal security. The EMR may be more secure for internal breeches of confidentiality, but must also be protected from foreign breeches such as hackers, who could potentially enter the EMR from an off-site location and download volumes of 4 confidential information. Firewalls and encryption software are methods used to protect patient data from these violators. Clinicians who use EMRs recognize two benefits: First, electronic access to clinical information saves time. Second, electronic access provides a thorough and efficient way to manage patient information. With EMR systems, comprehensi ve information can be located and presented in a way that is relevant to the task at hand. Dassengko and Slowinski) The obstacles identify have thus far been insurmountable, but the considerable achievements determine in the benefits section of this discussion suggest that the advantages are well worth the effort. As Lenhart et al state, â€Å" advantage comes at the price of considerable effort, persistence and optimism, as well as dedicated leadership. ” (p. 114) some organizations that invested in early EMR systems are struggling to show the soft benefits promised by vendors because an electronic version of current work processes is not cost effective. Sandrick) â€Å"If the ROI were a function of the information tool itself, the financial benefits would be hold outd universally. ” (ROI: The exsanguinous Paper. A Business Case for Electronic Medical Records) To get the most value out of an EMR, healthcare organizations must reengineer the following work process es to make full use of the system: Healthcare organizations must first train and motivate their users on how to navigate and become the EMR tools. To optimally use the EMR, it must be implemented from registration through billing, thus allowing the organization to work full potential benefits across the delivery system.These benefits include clear, concise, and comprehensive documentation, greater efficiency, care consistent with best practice guidelines and improved claims processing. 15 It is difficult to euphony the economic value associated with less tangible benefits such as higher quality of care, patient service, provider and employee satisfaction, and competitive advantage. It is even more difficult to allot necessary resources and commit to institutional change when the paper chart is â€Å"getting the job done,” even if it is not in the most efficient style.However, Carlon, suggests that all providers should embmce the EMR to deliver safe medical care. The infor mation in the EMR can reduce medical errors to avoid dangerous, sometimes lethal, mistakes. If organizations cant show that EMRs have a positive ROI, they may decide that the EMR is just another expense of running a business. The expense is to improve patient safety and reduce medical errors. This review of literature emphasizes that the use of EMR systems contributes to the ultimate goal of delivering effective care while improving patient safety. 16 3.Procedure and Methodology The study is an exploratory study conducted in Banjul, The Gambia, to examine the potential benefits ofEMR and its contribution to improving patient safety. For the most part, this study is descriptive and categorized as a non-experimental qualitative study. initial contacts were made with the Chief Medical Director, Development ships officer and the Head of Medical Records at the RVTH to solicit participants for the study. 3. 1. Experimental Design Survey approach was used to gain data from healthcare pr ofessionals who are considered potential users of EMR.Copies of the questionnaires were sent through e-mail to participants. A centre of 50 prospects containing 15 questions were sent out and 30 of them were returned. The meaning of the check over designed was open-ended questions based on the following areas: knowledge of EMR, benefits and challenges of EMR, transition from paper-based system to EMR, security issues associated with EMR use and assistance given to developing countries by developed nations to implement or use EMR. otherwise areas include, demographic details of respondents based on profession, duration of practice, age and sex.The survey questions can be found in the Appendix. Participants were selected based on their level of healthcare training. The population set for the study was healthcare professionals from the RVTH, which includes physician consultants, surgeons, pharmacists, nurses, midwives, pathologists, radiologists, and laboratory technicians. Study participants were limited to these previously mentioned health professionals, since they would be the principle users of an EMRsystem. 17 RVTH has a total population of about 500 professionals and a sampling size of 50 was chosen for the study.Since this was the first time such a study was being conducted in the country, there was limited knowledge of professionals on the matter as well as difficulty in getting volunteers to participate. 3. 2. Survey Procedure Survey questionnaires were converted into a PDF file and mailed electronically to all 50 participants on February 2, 2009. Unfortunately, quintuple medical professionals who were ab initio contacted to participate in the study later declined to take part ascribable to lack of understanding of the survey questions. As a result, contrasting participants were contacted to replace the five individuals to make up the sample size.Since the researcher could not travel to Gambia to facilitate the survey, one of the administrative officers at the hospital was contacted and helped to distribute hard copies of the questionnaire to all participants. Participants were communicate to fill out the attached survey and return it in a sealed envelope to this someone or the chief administrator. After three weeks, on February 23, 2009, a first reminder was mailed inquire for their cooperation and the importance of returning the survey. A final exam reminder was sent out on March 9, 2009, to those who cleverness have forgotten to return the survey. 8 3. 3. Data Analysis The 30 effectedd surveys were coded, sorted, and organized into themes. A spreadsheet was created in MS-Excel to enter all data for analysis. all in all responses were placed into themes and summarized. The survey responses and themes generated were used to determine result interpretation, recommendation, and future research direction. Despite initial difficulties to get volunteers to participate in the study, 30 out of the 50 surveys mailed were returned on March 16,2009, thus representing 60% response rate. 3. 4. Limitations of the studyDue to the difficulty of getting other hospitals in the area involved, the study was limited to RVTH only_ The findings represent views ofthat hospital alone. However, the research would have been more interesting and contend if more professionals from other hospitals were involved in the study. Secondly, cod to cost of air travel surrounded by the united States and Gambia, the researcher was not able to travel to Gambia to collect the necessary data for the study. The inability of participants to respond to some important questions on the survey skewed the data.Finally, out-of-pocket to the six hour time difference between Kansas and Gambia, it was hard to reach the participants at during business hours. Lack of high speed internet or sometimes no connection at all caused the check up on in receiving all the responses on time. It was also rightfully difficult to get sight to coope rate because the survey was not on their list of priorities. 19 4. Results found on the methodology, surveys were mailed to 50 participants at the RVTH in Banjul, The Gambia. Thirty completed surveys were received which included 15 questions.The results from all participants are as follows: The 30 respondents consisted of 17 males, 11 females and two people who did not indicate their gender. The age range of the group was 25-56. Table 2 presents the professional distribution of participants. No Response represents people who did not include their profession. The five students, however, included final year medical and dentistry students, as well as nursing, and medical laboratory students. Professional experience ranged between 1 and 20 years.Profession Surgeon apothecary Physician Radiologist Midwife Nurse testing ground Technician Student No Response Total Table 2: List of Professiona is, RVTH 2009 Number 3 2 3 2 5 6 2 5 2 30 20 To hit the books this result, key words such as c omputerized, storage and retrieval, were used to determine respondents understanding of the concept of an EMR system. Subsequently, third base of respondents (33. 3%) who included these three key words were marked as right. age nine people representing 20% who give tongue to it is a mechanism for storing patient medical record on a computer were assort as partially right and slightly half respondents (46. %) who just said the use of machine to keep patient medical data were classified as having an idea or understanding of the system. In addition, implementing and running a successful EMR system requires a number of key elements. Accordingly, 15 people identified technical elements such as (electricity, hardware, software, etc. ), 10 stated patient data, while four said nice trained soulfulnessnel, and one person indicated the need for money to train staff on EMR. withal availability of adequate infrastructure such as experts to support and train care providers on EMR is very crucial when implementing EMR system.However, more than half respondents assured that becoming infrastructures are not available in Gambia to support EMR implementation. On the other hand, 10 people conceived that infrastructures are available, while four said available infrastructures are only few. Despite unavailability of infrastructures, 16 respondents account there are enough computer experts in Gambia to train healthcare providers to use EMR. Seven inform experts are not available; six stated experts are available but too few to meet the demand and needed training requirement of the healthcare sector.Lastly, one person indicated he has no idea of the subject. Responses concerning how much developed nations are assisting less developed countries like Gambia with Health Information Management (HIM) system infrastructure 21 implementation showed various(a) opinions. Nine people said developed countries are helping, 15 responded no. However, six indicated that â€Å"the he lp given from developed nations are not enough and sometimes electronic devices sent to less developed countries like the Gambia are inferior and lack quality”.Still others phone â€Å"some form of assistance comes in to support the country on information management systems but not much is channeled towards the health sector”. Lastly, heptad people reported they have no idea â€Å"if developed nations are helping” and one person did not respond to this question at all. This pie chart downstairs shows the sources of funding and the amounts received for the year 2008. Sources of financing 2% • Gambia Government • Patient User Charges • part lineage • Internally Generated Fund • Global Fund Severe Malaria in African Children FundFigure 1: Sources of funding, RVTH 2008 22 The majority of funds come from the Gambia Government in the fonn of subvention received monthly or quarterly in advance. However, about 70% of the amount goes t owards retribution of salaries and allowances to approximately 1,200 staff. Other donations received are in the fonn of drugs, equipment, supplies and services which made considerable contribution to the hospital. (RVTH) 4. 1. Reasons why EMR is not being used at RVTH Paper records are bulky and can take up costly set.Filing, retrieval of files, and the re-filing of paper records are very labor-intensive methods with which to store patient infonnation. Plus if a record is checked out for one department, another department cannot access the chart. The impact of not having fast access to key infonnation in emergency situations can be serious. Paper medical charts also cannot be effectively searched and used to track, analyze, and/or chart rich clinical medical infonnation and processes. They cannot be easily copied or saved off-site.Also physicians orders and the corresponding results such as medications and labs can be issued and saved in a comprehensive EMR system. Our literatur e review and results have proven that paper records are costly, cumbersome, misinterpreted, easily misplaced and cannot be used for any meaningful decision analysis. Unfortunately, RVTH does not have any EMR system in place to improve patient safety. As noted-by participants, â€Å"EMR software is not used at RVTH because administration keeps complaining of the lack of money. It looks expensive to them and also they are more used to the paper folder”.Nevertheless, four key issues were identified by participants as the main reasons why RVTH does not have an EMR system in use. 23 Overall, 36% of respondents attributed the problem to lack of resources in legal injury of personnel and infrastructure, 29% blamed it on lack ofleadership initiative and priority. While 18% reported cost in terms of equipment and training personnel, 15%, however, stated lack ofEMR importance or awareness and fear to change. Lastly, 2% respondents did not give any reason. 4. 2. Benefits and challenges of EMR There are both benefits and challenges to EMRs.Many argue that positive aspects of using an EMR system outdo the challenges. Even though the investments in EMR systems are costly, most argue that over time this outset cost will result in greater savmgs. As well as cost saving, many agree that one advantage of EMR system is that they save space. kinda of keeping huge paper files on patients, all records are kept on computer files. Though someone must store these records in computers, this still represents a small percentage ofthe space required to store physical records. Along with saved space is reduction of paper used by hospitals.Although EMR systems do not render paper obsolete, but they sure as shooting do reduce needed paper significantly. Another advantage of electronic medical records is the ability for all in a health care police squad to coordinate care in terms of observe and treating diseases. This helps avoid duplication of testing, prescribing medicines th at in combination expertness be dangerous and the ability for anyone on the medical team to understand the approaches taken to a condition. A person with complex health issues may see several specialists, and can easily become disjointed by overlapping or contrary advice.When specialists and primal care resorts use the same system for electronic medical records, then everyone on the team would be aware of all the other team members actions and recommendations. Electronic medical records may save time as well. Though faxing and email may assist one doctor to get information from another doctor or a laboratory, there is generally a wait time to receive this information. When a doctor has instant access to all of a patients information, including things like x-rays, lab tests, and information about prescriptions or allergies, he or she is ready to act right away, thus saving time.This may be particularly accommodative in emergency situations where a patient cannot dissolver quest ions about medical history or allergies due to extreme illness or injury. Generally, doctors are a good deal considered to have the worst handwriting, though this is just a generalization, unclear writing can lead to misinterpretations and mistakes. Typed notes and prescriptions are more legible and less likely to create misunderstandings. However, electronic medical records do not obtain out the occasional typo. One of the main disadvantages to EMR system is that start up costs is enormous.Not only must you buy equipment to record and store patient charts (much more expensive than paper and file cabinets), but efforts must be taken to convert all charts to electronic form. Patients may be in the transitional peak where old records havent yet been converted and doctors dont always know this. Further, training on EMR software adds additional expense in paying people to take training, and in paying trainers to teach practitioners. In fact, one concern about the use of electronic me dical records is that doctors may have a significant learning draw in when these programs are first implemented.A poor 25 typist may actually take a long time to input information. Doctors often have to be their own medical clerks especially during an office visit, and a doctor distracted by confusing technology may not be as alert to a patients symptoms or needs. There is no single electronic medical records source or system, so different hospitals and individual clinicians may not all be using the same program. This negates the possibility of instant information for all on the medical team, since one program may not communicate with another.Another concern is that electronic medical record systems might be hacked and use by others. Since one of the first considerations of medical treatment is confidentiality, it may remain a concern about how many people may have access to other medical records which they are not authentic to do so. Misuse of private medical information could c reate problems for people who have conditions they wish to keep private. Despite these concerns, it appears many hospitals are now attempting to use EMR systems.It remains unclear how long it will take for hospitals to transition completely from the traditional paper-based systems to a complete paperless environment. As shown from the survey results, it is clear that many participants think that implementation ofEMR will tremendously improve upon patient in the country. For instance, as noted by one respondent, â€Å"availability of patient past history in electronic format will enable health care workers have information about patients in seconds and with ease which will facilitate quick diagnosis and treatment hence reducing the rate of mortality. 26There is always some level of fear and resistance to change, especially in the healthcare industry. A question concerning the level of acceptability from the traditional paper-based system to EMR system shows that such change will be met with some difficulties. more(prenominal) than half of respondents said the process would be challenging initially, but eventually care providers will accept the system because it will improve patient safety and work performance. Although the majority may still prefer the paper-based system, â€Å"they will change when they see the importance or need for EMR” stated a participant.Others also believe it would be a â€Å"welcome idea”. The adequate protection of patient health record requires limitations at all levels, such as: collection, use, access, and disclosure. Therefore, development of privacy, confidentiality, and security principles is necessary to protect patients interests against inappropriate access to their health data. Unfortunately, 14 respondents (47%) did not respond to this important question regarding measures necessary to maintain patients privacy, security, and confidentiality at RVTH.However, 16 people representing (53%), did state that all health records must be securely protected by use of password, data encryption, and access restrictions to users. It is obvious from the survey results that effective implementation and utilization ofEMR can improve patient safety in developing countries. Considering training as one of the key elements to EMR success, a question was asked to determine space of time required to train care providers in Gambia on EMR.Almost 50% of respondents indicated it might take 6-18 months depending on â€Å"practitioners ability to understand the concepts ofEMR as well as the user friendliness of the software”. Others believe â€Å"for 27 current medical students who are already computer literate may take about two weeks, but the older practitioners will take eight-day time (approximately over a year)”. Table 3, below shows the number of respondents that own a computer or has had some form of computer training in the past. Computer Training Profession Own a Computer 1 1 1 0 1 2 1 2 I Yes 1 1 1 0 2 3 1 7 16\r\n'