Keywords
Electronic health recording system, user satisfaction, Ethiopia and evaluation
This article is included in the International Conference on Family Planning gateway.
Electronic health recording system, user satisfaction, Ethiopia and evaluation
EHR, electronic health record system; HIMSS, health information management system society; MCH, Maternal and Child health; MSIE, Marie Stopes International Ethiopia
The Health Information Management Systems Society’s (HIMSS) define EHR as: “The Electronic Health Record (EHR) is a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information, are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports” (Ahmed et al., 2013).
Recording of patient data on paper obstructs the coherence and nature of medical care offered to patients. Furthermore, paper-based frameworks have restricted usefulness, limiting reviewing of medical records by care givers simultaneously. Storage of paper records takes up more space and hinders easy access to patient information (Carayon et al., 2009). By contrast, EHR can create a complete patient record of the entire clinical experience. The system automates the clinical work process and improves quality of care (Ahmed et al., 2013). Patient records can also be easily retrieved using the patient’s name, phone number or registry number.
Currently, paper-based recordings are being migrated to electronic recording systems because electronic health recording (EHR) systems improves quality and adaptability of care recording, contributing to patient safety. The system is also efficient and provides real-time administration to patients (Rezaeibagha et al., 2015). Therefore, using HERs is an essential part in health care delivery to improve quality and safety (Ellsworth et al., 2017). The US Institute of Medicine has characterized EHRs as an essential technology for improving the safety, quality and efficiency of health care (Chiang et al., 2013).
An assessment of nine hospitals that implemented a comprehensive electronic health record (EHR) system discovered an improvement on the speed and accuracy of communication leading to less duplicative tests, quicker responses to client’s needs, and a complete capture of charges (Silow-Carroll et al., 2012).
The averted costs associated with efficiencies created by maintaining and availing patient data electronically contributes to the financial benefits of the EHR system. Some of the averted costs are related to reduced staff number required in patient management, reduced stationary and printing costs required to maintain paper records (Menachemi & Collum, 2011).
On the other hand, a study done in a residency’s family medicine center in Birmingham, AL, USA, revealed that Physicians and residents are very dissatisfied with the amount of time required for documentation using the EHR system (Bloom & Huntington, 2010). Following the implementation of EHR, both clinical staff and office staff spent more time on transcribing data to computer to maintain medical information system (Carayon et al., 2009).
In this study we will evaluate the EHR system implemented in three of the MCH centers in Marie stopes international Ethiopia (MSIE). The study will evaluate ease of performing tasks and satisfaction with the system in six departments (inpatient, outpatient, pharmacy, laboratory, reception cashiers and MCH managers). Each department performs a unique task that contributes to the overall performance of the facility. Thus, we hypothesized that the ease of performing tasks and satisfaction with the EHR system varies by department and by specific task within a department.
We used a cross-sectional study with formative evaluation method to address the objective. At the time of the investigation there were 134 staff members from three of the MCH centers using the EHR system in their daily activities. Of the 134 staff members, only 68 fulfilled the selection criteria of working 6 months in the MCH center prior to the implementation of the system. From the selected 68 staff members, only those trained by MISE about the system were selected as final study participants. Therefore, a total sample size of 54 participants were used for the investigation. The participants were from six departments (inpatient, outpatient, pharmacy, laboratory, reception cashiers and MCH managers) within three MCH centers.
Data was collected using structured, self-administered questionnaires and interviews (available as Extended data (Sharew, 2019)). The interviews were conducted with two people from each department to find out their daily tasks. Then a unique set of task list was prepared for each department. Using these task lists, a different questionnaire for each of the six departments were developed. The questionnaires involved a section where the respondents answer by ticking and a section where respondents are asked to answer by writing.
Data were then checked for completeness, consistency and analyzed using SPSS for Windows v20. The usefulness dimension was measured by how the participants found the system affecting their day to day activities and operations. The user satisfaction-dimension was measured for relevant aspects. Each dimension and their indicators were judged using a judgement criterion: >95% excellent, 80–94% very good, 65–79% good, 50–64% fair, <50% poor. Descriptive statistics tables and graphs will be used to describe the findings.
The study was conducted after ethical clearance was obtained from the Institutional Ethical Review Committee of Addis Ababa University School of Commerce. During the data collection period, the participants were well informed about the purpose of the study. Written informed consent of the respondents was obtained before the commencement of the study. Involvement was fully decided by the participants. The response was confidential. Monitoring and supervision of data collectors was done throughout the whole data collection period. To assess the completeness, clarity and consistency the collected data were checked daily after data collection.
Of the total 54 respondents, 17 (31%) were from the inpatient department and 18 (33%) were from the outpatient department. Of all the participants, 31 (57%) worked between 4 and 5 years with the organization. Of the respondents, 14 (26%) were nurses and 11 (20%) were midwives (Table 1). Results from all surveys and questionnaires are available as Underlying data (Sharew, 2019).
Most participants from the inpatient department agree that the EHR system made their daily tasks easier. Admitting patients, following admitted patients’ medical usage and monitoring consumables during procedure were indicated by all the participants from the department as activities made easier following EHR implantation (Table 2). Similarly, a study done in a small family practice clinic in USA also indicated an increase in time spent on patient care and decrease in time spent in meeting and performing lab works (Carayon et al., 2009).
In total, 94% of those in the outpatient department felt EHR made performing tasks easier (Table 3). All respondents agree that the system made it easier to seek out specific information from the client record, to produce data reviews for specific patient groups, to order clinical laboratory, to order and receive ultrasound results and to write prescription. However, only 61% of the respondents agree that the system made it easier to complete sick-leave forms.
The result showed that the system made it easier to know available drugs in the dispensing area and billing for medications. However, the respondents indicated that the system made the it difficult to rule out drug interactions and maintain allergy and active medication lists (Table 4). The study revealed that the need and the requirements of pharmacy department had not been reflected in the system design. The agency of healthcare research and quality to support research policy information in the area of EHR indicated that, if effectively implemented, EHR system reduces the need to rely on memory alone for information required to complete a task such as medical history, allergies and formulations (Armijo et al., 2009).
The overall ease of performing tasks using EHR in laboratory department was 82%. From the list of activities performed in laboratory department, only half of the agree that the system make processing lab packages by category of services easier (Table 5).
All the respondents, reception cashiers, showed that the system made their daily task easier (Table 6).
MCH managers found the system easy to use when performing most of their day to day activities. However, 67% of the respondents indicated that the system makes it difficult to do income to cost ration (Table 7). Similarly, a survey done in Australian hospitals revealed that a majority of managers (82%) stated that EHR improved data quality by readily availing information and improving the legibility of records (Mckenzie, 2003).
When participants asked to rank their satisfaction with various aspects of use, total reported satisfaction with the EHR system (agree/strongly agree) was 87% (Figure 1). With the work they do on EHR system, inpatient staff were least satisfied (72%) followed by outpatient (74%) and pharmacy department (76%).
Staff in all department reported the EHR system ease of use as ‘very good’ for ease of performing their daily tasks using EHR system. The lowest score for ease of performing tasks was from pharmacy department and highest score was from reception cashiers. The reported satisfaction with the system was also high. In addition, the study revealed that ease of performing tasks using EHR and satisfaction with the system varied by department and by task within a department. It is essential to know the needs and requirements of each department before implementation of the system and getting user feedback for long lasting uptake and impact. It is also imperative that the workflow and information needs of each unit are met to optimize system utilization resulting quality of care.
Figshare: Evaluation of EHR system. https://doi.org/10.6084/m9.figshare.8203172 (Sharew, 2019).
This project contains the following underlying data:
Figshare: Evaluation of EHR system. https://doi.org/10.6084/m9.figshare.8203172 (Sharew, 2019).
The project contains the following extended data:
questionnaire.pdf (questionnaire used in the present study with consent form)
Interview guide.pdf (survey given to all participants)
Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).
The authors take pride in acknowledging the insightful guidance of Teshager Mersha, and Mathias Tenaye. We wish to thank Gizaw Sharew and Wogayehu Mamo for their support. We also appreciate the hardworking and committed service providers in three of maternal and child health centers.
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Is the work clearly and accurately presented and does it cite the current literature?
Partly
Is the study design appropriate and is the work technically sound?
Partly
Are sufficient details of methods and analysis provided to allow replication by others?
Partly
If applicable, is the statistical analysis and its interpretation appropriate?
Partly
Are all the source data underlying the results available to ensure full reproducibility?
Yes
Are the conclusions drawn adequately supported by the results?
Yes
References
1. Grimshaw J: SURGE (The SUrvey Reporting GuidelinE). 2014. 206-213 Publisher Full TextCompeting Interests: No competing interests were disclosed.
Reviewer Expertise: Public health policy.
Is the work clearly and accurately presented and does it cite the current literature?
No
Is the study design appropriate and is the work technically sound?
Partly
Are sufficient details of methods and analysis provided to allow replication by others?
Partly
If applicable, is the statistical analysis and its interpretation appropriate?
I cannot comment. A qualified statistician is required.
Are all the source data underlying the results available to ensure full reproducibility?
Yes
Are the conclusions drawn adequately supported by the results?
Partly
Competing Interests: No competing interests were disclosed.
Reviewer Expertise: AI, Big data analytics, EHR.
Alongside their report, reviewers assign a status to the article:
Invited Reviewers | ||
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Version 1 07 Nov 19 |
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Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. Consider the following examples, but note that this is not an exhaustive list:
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