Following immense technological advancement in the 21st century, the implementation of information technology in healthcare has increased tremendously. Consequently, this adoption has triggered unprecedented research that is aimed at exploring the implications of information technology in healthcare. Recently, researchers have been concerned about the application of information technology in medical record management in the new dawn of Electronic Medical Records (EMR) (Braa et al. 381). For the last two decades, medical record management has witnessed great evolution, both in developed and developing countries. However, the replacement of paper-based records with EMR systems has been rapid in western countries, and painfully slow in developing countries. In addition, some of the countries are yet to embrace this significant technology (Fraser et al. 84). On the same note, this paper will focus on the development and progression of EMR systems in developing countries. It will also analyze various case studies to highlight how developing countries are adopting EMR systems in their healthcare models. In addition, some potential benefits and challenges that hinder the rapid adoption of EMR systems in developing countries will be explored.
Background of EMR systems in developing countries
Health care infrastructure in developing countries is greatly underdeveloped, despite the numerous deadly diseases such as Human Immunodeficiency Virus and Malaria that continue to affect the population (Douglas et al. 2). Noticeably, although developed countries are also affected by these diseases, advancement in healthcare infrastructure reduces the devastating effects of these diseases (Douglas et al. 3). One of the most noticeable healthcare infrastructure developments in developed countries’ healthcare is the adoption of EMR systems. Conversely, most developing countries are still ensnared in paper-based medical records, which have lost their sufficiency in the 21st century (McGinn et al. 47).
Numerous studies have positively exposed that paper-record systems are inefficient in simplifying healthcare providers’ requirements (Faustine & Boren 140). Most researchers have cited that paper-record systems hamper communication between care providers, especially in developing countries, where these records have to be hand-delivered from one care provider to another. The hand-delivery method is time-consuming not forgetting that medical attention is a matter of emergency (Rochelle & Courtney 75). Furthermore, in paper-record systems, it takes a long to carry out tests because patients have to transmit paper requests to the laboratory and back to the doctor for treatment to be administered. This further contributes to the inefficiency of health care delivery models (76).
According to Faustine and Boren, these aforementioned inefficiencies associated with paper-based medical records can be addressed through the adoption and implementation of EMR systems (141). This is because EMR systems facilitate communication between healthcare providers whereby by pressing the sent button, records are delivered to the intended destination instantaneously. Thus, in turn, an EMR system enables healthcare providers to save extra time and manpower and subsequently improves healthcare model efficiency (Faustine & Boren 142). Furthermore, the adoption of EMRs in developing countries would improve the quality of health care that is currently lacking (Rochelle & Courtney 76).
Potential Benefits of EMR in Developing Countries
While the development and implementation of EMRs have proven to be challenging for developed countries, the challenges and limitations are more pronounced in developing countries (Fraser et al. 83). Notwithstanding the myriad challenges, Fraser et al. underscore that some developing countries have portrayed victory in the development and implementation of EMR systems (84). Consequently, these countries have been able to realize numerous potential benefits associated with EMR technology. In addition, various study findings have indicated that EMR systems are capable of promoting the management of healthcare in both developed and developing countries (Fraser et al 84).
To begin with, Faustine and Boren underscore that with EMR systems, it is easier to read clinical notes without struggling with poor handwriting, which was previously the case with paper records (142). By so doing, whoever is reading these notes is able to obtain crucial information about drug prescriptions, drug incompatibilities, and drug allergies. In addition, EMRs act as a reminder to the concerned parties about diminishing drug prescriptions; caution against abnormal lab results, and remind clinicians about remaining vaccinations (Fraser et al. 85). According to Faustine and Boren, EMR systems have been successfully utilized to keep track of ongoing programs by monitoring outcomes, supplies, and budgets (140). The latter authors also underscore that EMR systems can be effectively utilized to support clinical research as well as assist in the management of chronic diseases such as heart failure, hypertension, and diabetes (141). Similarly, the management of paper- records is incredibly costly as compared to EMRs that have been recognized as cost-effective by reducing the overall cost of operations by over $86,400 every five years (Fraser et al 87).
Cases studies of EMR in developing countries
The adoption of EMR systems is a daunting task. In spite of the fact that developed countries are leading in the implementation of EMRS, the uptake in the United States is still insignificant (Douglas et al. 4). The latter authors underscore that despite the milestone adoption of EMRs in the United States, it is approximated that only a mere 9% of the entire hospital’s population are currently using EMR systems.
India and Kenya
Conversely, hospitals in India have been swift to embrace EMRs with the current status estimated at 60%, with most emphasis on medical records that are utilized in surgery rooms (Faustine & Boren 142). Similarly, the development and implementation of EMRs kicked off in 2001 in Kenya. Initially, an EMRs system named Mosoriot Medical Record System (MMRS) was developed, but it was later upgraded to AMRS. The system is capable of providing electronic medical records services to over 60,000 patients. AMRS which is supported by Microsoft access software is capable of networking two or more computers, which are usually backed up by Uninterruptable Power Supply (UPS) to avoid disruptions in the event of power interruptions (Faustine & Boren 142). During the initial visit to EMRs enabled hospitals, patients are required to register their details with the first clerk where they are issued with a coded number that is used to identify them at the various departments within the clinic (Faustine & Boren 143). According to Fraser et al., post-implementation surveys have indicated that EMRs have promoted great improvements in healthcare service delivery (87). For instance, after implementing AMRS systems in Kenya, patients’ waiting time was reduced by 38%, patients’ visits to the clinics were reduced by 22% because they could get their test results within the shortest time possible, time spent during clinical personnel, and patient interaction was reduced by 50%, while interaction between clinical personnel reduced by over 67%, thus, in turn, clinics ended up serving more patients contrary to what was being witnessed previously (Faustine & Boren 143). Conversely, Braa et al. underscore that the aforementioned results were only possible if clerks succeeded in transcribing the visit’s data without errors (387).
In Peru, an EMR system was established in 1996 whereby through collaboration with Partners in Health an open-source web system was developed (Rochelle & Courtney 79). Currently, the system has a capacity of serving approximately 4300 patients. In order to facilitate the implementation of EMRs, an oracle database was developed, and it is updated every time an old or new patient visits the clinics (Rochelle & Courtney 79). The attending physicians fill out paper-based patients’ forms and the nurses and other assisting staff key this data into the system. Following the implementation of this system, medication errors showed a decline of 17.4% contrast with what was being witnessed previously. In addition, dispersing errors at the clinic’s pharmacies declined significantly. Apparently, this is a clear indication that web-based approaches are better than paper-based procedures (Rochelle & Courtney 82). The downside to this system is that it requires a reliable internet connection which might not be available in most low-income countries (83).
Correspondingly, Partners in Health also introduced a similar open-source system in rural Haiti in 1999 (Braa et al. 386). However, since this location lacked adequate infrastructures such as roads, electricity, and telephone service, the system was modified to allow offline connectivity. This was a great achievement owing to the fact that the system could serve 4000 patients despite the myriad shortcomings. The additional offline client system permitted data entry and permitted clinicians to review patients’ cases even without an internet connection (Braa et al. 388). The latter authors underscore that the Peru case study is a clear indication that inadequate infrastructure is not an excuse to shy off from adopting EMRs to eliminate the numerous inefficiencies associated with paper-based records (400).
On the same note, Uganda has an operational EMR system known as the Cereware system (McGinn et al. 48). This database can either be accessed from a single computer or a network. It was developed in 2003 by a U.S based team from the Department of Health and Human Services to support the management of HIV treatment records (McGinn et al. 48). The system which has been installed in various sites across the country serves a great number of patients whereby it grants healthcare providers a reliable system to keep track of HIV patients’ records and subsequent treatments. Data entry is made by clerks from paper forms while physicians can also enter patients’ information directly (McGinn et al. 49). Similarly, the Cereware system is widely deployed in United States hospitals to facilitate the distribution of medication, clinical assessment, and billing (McGinn et al. 50). This system has turned out to be a blessing in Uganda by promoting the accessibility of ARVs by HIV patients, thus reducing the devastating effects of this pandemic (McGinn et al. 51).
Malawi has an advanced EMR system known as Touch Screen EMRs system. The touch screen system was introduced in 2001 and it was utilized in the pediatric department to solve the myriad clinical problems (Douglas et al. 3). This pilot study paved way for an extensive EMR system that currently serves 60, 000 (R Douglas et al. 3). The client programs are supported by Linux/MySQL software, which supports the local area network. In this system, clinicians, nurses, and pharmacists enter patients’ data using the touch screen method. Consequently, the system enables clinicians to access patients’ history including their demographics, laboratory, and X-ray test results, and medication prescription (Douglas et al. 4). However, the system is not user-friendly as it is quite hectic to enter free text data via touch screen mode, but users can also opt for an ‘on-screen’ keyboard (Douglas et al. 6). Notwithstanding this shortcoming, EMRs in Malawi have portrayed great success and the acceptance among medical staff users has been immense (6).
Brazil has also followed in comparable footsteps by adopting a Computerized System for the Control of Drug Logistics (SILCOM). This program, which is utilized within the entire Brazilian public healthcare system was developed to facilitate the delivery of ARV to over 100, 000 AIDS patients (Rochelle & Courtney 75). This number is the largest for any EMR system that has been developed in developing countries (Rochelle & Courtney 76). Physicians are provided with desktops that are interconnected to a central server that updates new record entries periodically. The SILCOM system, which operates in the Portuguese language, has been erected across various sites throughout the Brazilian republic (Faustine & Boren 142). As the name suggests, the system facilitates the monitoring of medical supplies and guides pharmacists while dispensing medications (Rochelle & Courtney 75). According to Faustine and Boren, the system has generated immense benefits by enabling the public health system to overcome logistical challenges while providing ARV treatment to AIDS patients (142).
Challenges of EMRs in developing countries
On the other hand, despite the numerous benefits associated with EMRs, various shortcomings persist especially during the initial implementation stages (Faustine & Boren 412). This is because for implementation to be effective, several factors such as infrastructure (electricity, internet), population demographics, and locality have to be considered (413). However, poor infrastructure should not act as a barrier to the adoption of EMRs, and the countries that are yet to implement should borrow knowledge from the Haiti case study. Moreover, the initial implementation costs of EMRs can be awfully costly for developing countries (Fraser et al 86). As aforementioned, victorious cases of EMRs adoption in countries like Kenya, Uganda and Haiti have been made possible through collaboration with international donors. The gravity of the matter is that the rigidity of some physicians, who are yet to realize the potential benefits of EMRs may hinder the successful adoption of EMRs in developing countries (Douglas et al. 4). Despite these aforementioned barriers, several developing countries have undertaken significant strides towards the development and implementation of EMR systems, and health users in Kenya, India, and Haiti have been reaping the associated benefits for some time (5).
EMR implementation for Developing Countries
However, despite the numerous benefits associated with the development and implementation of EMRs in developing countries, Rochelle and Courtney identify some key considerations that should be addressed prior to the adoption of this significant system.
Cost, language, and culture
Apparently, EMRs require a considerable among of time before the return of investment can be realized. This is especially so in developing countries because the cost input of developing and implementing EMRs is quite high as compared to developed countries (McGinn et al. 52). For this reason, most healthcare entrepreneurs have shunned away from adopting these systems regardless of the numerous potential benefits. Furthermore, without assistance from donors, some poor countries would be unable to adopt EMRs, and in some critical situations, some are not in a capacity to sustain the already implemented systems (Faustine & Boren 143). On the same note, the issue of language barriers threatens to cripple efforts of EMR systems adoption in developing countries (McGinn et al. 53). The latter authors underscore that language diversity is both a blessing and a curse in developing countries because EMRs developers are always in a dilemma while deciding the most suitable language for the users and consumers (54). However, countries like Kenya have opted for both English and Kiswahili languages, which are regarded as official and national languages respectively, in order to harmonize their linguistic diversity (McGinn et al. 52). Rochelle and Courtney posit that numerous studies have also been dedicated towards the understanding of the role of cultural dimensions of technology about their impact on the acceptance of information technology systems in general (80). Peoples’ cultural beliefs and values greatly impact their acceptance of new technological innovations (Rochelle & Courtney 81). As aforementioned, some rigid physicians have been blamed for debilitating governments’ efforts in developing countries to implement EMRS within their healthcare systems. More often than not, cultural technological beliefs are usually determined by the level of technology exposure encountered by an individual. This implies that the implementation of EMR systems in urban areas might encounter less resistance as compared to rural settings where technological exposure is minimal (Rochelle & Courtney 81). On the same note, cultural technological hindrances are likely to be more pronounced in developing countries than in developed countries which are still lagging in ICT diffusion (Braa et al. 392).
Technology and infrastructure
Correspondingly, developing countries are still lagging in technological infrastructure, which further hinders the effective development and implementation of EMR systems (Braa et al. 392). These systems are operated using computers whereby the servers are supposed to be powered on a 24/7 basis (Braa et al. 394). However, developing countries are inflicted with power supply interruptions due to various reasons. On the same note, internet connection is a significant prerequisite towards the implementation of EMR systems. However, due to poor penetration of ICT infrastructure in developing countries most EMR systems have been unable to kick-off due to poor or absent internet connections (Fraser et al. 86). Nonetheless, Haiti has succeeded in overcoming the infrastructure barrier by developing offline systems that do not require 24/7 connectivity (McGinn et al. 49).
Security, Confidentiality, and Reliability
Medical records are highly sensitive and databases ought to be secure, confidential, and reliable (Rochelle & Courtney 82). Analogous to what has been observed in developed countries, medical data is prone to security and confidentially issues that threaten to disintegrate the reliability of EMRs systems. Correspondingly, the issue of confidentiality is colossal in developing countries since most data in these systems is centered on HIV treatments vis-à-vis that HIV infections still attract a lot of social stigma in these countries (McGinn et al. 52). This implies that great care both in terms of technical and human protocols ought to be observed during the development and implementation of EMRs in both developed and developing countries (Faustine & Boren 142). In addition, confidentially issues should also be observed during the actual utilization of these systems to ensure that they preserve their credibility among users and consumers (143).
The execution of a substantial number of EMR systems in developing countries such as Kenya, Malawi, Haiti, Uganda, and Peru is highly encouraging. However, some concerns regarding security, access, cost, technological resistance, reliability, internet, cultural and language barriers threaten to debilitate developing countries’ efforts towards the adoption of EMR systems within their healthcare systems. Nonetheless, these challenges should not dissuade efforts towards the implementation of EMR systems, owing to the numerous potential benefits associated therein. Furthermore, following that developing countries are still struggling with various devastating diseases, there is a pressing need for EMR systems, which have been highly praised for improving the quality of care.
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