IMPLEMENTING ELECTRONIC HEALTH RECORDS IN PRIMARY

HEALTH CARE Issues and Challenges

By: Fides Simbulan, RNHealth Informatics 201

Unique Patient Identification for all Filipinos

The most basic requirement in a pursuit towardsElectronic Health Records (EHR). Used to track an individual and all records in different primary facilities, and eventually in all other levels of healthcare.

- The full implementation of House Bill 5060, or the proposed “Filipino Identification System Act, is a huge step to make this possible in Primary Health Care where not all citizens would typically and possibly be identified by their SSS Number, TIN, etc.

Unified Data Dictionary

Data Dictionary must follow Clinical Data Standards to ensure a standard meaning across all records. Standard terminologies must be in place for the use of all.

To be able to address Clinical Data Entry issues, all users must be educated and trained of the use of Data Dictionary and its contents.

One major concern in this aspect is the existence of different dialects in different places, the Philippines being an archipelago

Computer LiteracyTraining and education of clerks and other

barangay health workers must consist of Computer Literacy aspect for EHR implementation

- DOST’s project with INTEL Philippines, DigiBayanihan (among other movements) aims to cover this challenge that we are facing with a national digital literacy movement. This movement aims 5 million computer literate Filipinos by the end of 2015.

Funding Allocation

The Health sector must weigh the cost benefit analysis in the long term use of an EHR, against the manual system.

Funding should include total costs of Infrastructure (especially in Primary health care facilities where technology does not penetrate well), System Implementation, Training and Education, Support and Maintenance, Research and other special concerns to maximize the use of HER upon implementation

Privacy of Information and Unauthorized

DisclosureThe implementation and use of EHR brings about

concerns in terms of information privacy and patient confidentiality

This must be covered with an existing law, aligning the advocacies of Data Privacy Act of 2012

Concerns on the Filipino people being not aware of the privacy concerns in use of electronic medical records must be addressed by the health sector for equality and right to privacy.

Capacity Building Knowledge and expertise are vital in sustaining a system

implementation. One of the hurdles in areas of primary care is the expertise of personnel involved in maintaining a computerized system

The Health Sector must find project allocation lineups relating to strengthening skills and competencies of Barangay Health Workers and other Primary Health Workers

This also includes training of all end users for a cost-effective implementation of EHR

Healthcare IT Infrastructure

Incompatibilities Information Technology Infrastructure

in the barangays and far-flung areas are mostly non existent or not strong enough to handle huge systems like EHR

This includes: Computer platforms, Data Management Storage, Network and Telecommunications platforms, Internet platforms, and even technical support

Other concerns are insufficient electrical supply and inadequate data back up

Knowledge and Information

DisseminationPeople involvement in creation and

implementation of an EHR is one of the key points concerning implementation in primary healthcare

The local population will support and maintain a system when the sense of ownership is present

All target users, maintenance staff and workers, and even the administration must be well knowledgeable on the benefits of an EHR implementation to ensure compliance

References: Chapter 3. Issues and Challenges in Electronic Health Records: A

Manual for Developing Countries. World Health Organization, 2006. http://www.wpro.who.int/publications/docs/EHRmanual.pdf

Tierney, William M., et al. "Experience implementing electronic health records in three East African countries." Stud Health Technol Inform 160.Pt 1 (2010): 371-5.

Sood, Sanjay Prakash, et al. "Electronic medical records: a review comparing the challenges in developed and developing countries." Hawaii International Conference on System Sciences, Proceedings of the 41st Annual. IEEE, 2008.