EMR Advantages and Adoption Challenges
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The document discusses the challenges and barriers to adopting Electronic Medical Records (EMRs) in clinical practice in the Philippines, highlighting the low level of adoption among hospitals and private practices. It identifies cultural, financial, and infrastructure issues, as well as misconceptions from both physicians and patients regarding the effectiveness and security of EMRs. The document emphasizes the need for better education, user-friendly technology, and compliance with data protection regulations to facilitate EMR adoption.
EMR Advantages and Adoption Challenges
- 1. EMR: ISSUES AND CHALLENGES IN THE CLINICAL PRACTICE
- 2. IN THE PHILIPPINES EMRS ARE NO LONGER THAT UNUSUAL
- 3. ONLY LARGE MEDICAL CENTERS USED THEM BEFORE,
- 4. PRIVATE CLINICS AND GROUPS USE EMR’S TODAY,
- 5. BUT THEY'RE STILL FAR FROM "A GIVEN"
- 6. ON THE HIMSS EMR ADOPTION SCALE, MOST HOSPITALS HERE ARE ONLY AT STAGE 1 The Healthcare Information and Management Systems Society is a global nonprofit focused on better health via information & technology.
- 7. VERY LOW, AS THE HIMSS EMR ADOPTION SCALE GOES UP TO 7
- 8. STAGE 1 PHARMA, LAB, AND RADIOLOGY INFO SYSTEMS INSTALLED
- 9. STAGE 2 INTERNAL INTEROPERABILITY FOR INFO SYSTEMS (FEEDS DATA TO A SINGLE CLINICAL DATA REPOSITORY, HAS BASIC SECURITY, ETC.)
- 10. STAGE 3 NURSING AND ALLIED HEALTH DOCUMENTATION; ROLE-BASED SECURITY
- 11. STAGE 4 COMPUTERIZED PRACTITIONER ORDER ENTRY (CPOE) WITH CLINICAL DECISION SUPPORT (CDS); NURSING AND ALLIED HEALTH DOCUMENTATION; BASIC BUSINESS CONTINUITY
- 12. STAGE 5 PHYSICIAN DOCUMENTATION USING STRUCTURED TEMPLATES; INTRUSION/DEVICE PROTECTION
- 13. STAGE 6 TECHNOLOGY ENABLED MEDICATION, BLOOD PRODUCTS, AND HUMAN MILK ADMINISTRATION; RISK REPORTING; FULL CDS
- 14. STAGE 7 COMPLETE EMR, EXTERNAL HIE (HEALTH INFORMATION EXCHANGE), ANALYTICS, ETC.
- 15. THE SAME IS THE CASE WITH PRIVATE PRACTICE DOCTORS
- 17. WHY?
- 18. WE KNOW WHY EMRS ARE PRACTICALLY PREFERABLE TO PAPER RECORDS.
- 19. PAPER EMR Accessibility Where You Left It Anytime, anywhere Processability No Reports/research Durability No Automatic Backups Security Cabinet or Door Lock Encryption, compliance to international standards etc.
- 20. OF THESE BENEFITS FACILITATES ADOPTION RISING AWARENESS
- 21. OTHER FACILITATORS: ▸ improving technology ▸ increasing comfort with progress ▸ patient interest, etc.
- 25. “IT'S TOO MUCH CHANGE TOO FAST.” DOCTOR
- 27. IS BOTH CULTURAL & INTELLECTUAL THIS BARRIER
- 28. ▸Cultural due to innate conservatism ▸Intellectual due to lack of information/ awareness about EMR’s
- 29. THERE'S MORE THAN 1 TYPE OF EMR MOST DON'T KNOW
- 31. ON-PREMISE (LOCAL SERVER + NETWORK)
- 33. It doesn’t need internet but you’ll need to setup an internal network You’ll need a team or contractors to maintain it Implementing new workflows will entail more costs It scales as your facility grows It’s crazy expensive to implement Data is stuck internally, in the location ON-PREMISE
- 36. It doesn’t need internet You’ll have to back up your own data Implementing new things will depend on the developer It won’t scale Medium or High initial investment (depends on the provider) Data is stuck in your device Hard to migrate to new devices STANDALONE
- 37. CLOUD-BASED
- 38. Requires internet Backups are automated New features can be released over the internet It easily scales as your practice grows Low investment cost, existing hardware can be used You can access data 24/7 CLOUD BASED
- 40. FOR EXAMPLE…
- 41. STANDALONE EMR SYSTEMS CONCERNS OVER LACK OF SECURITY =
- 42. STANDALONE - SOFTWARE INSTALLED HOW MANY TIMES HAVE YOU HEARD OF THIS? ▸ Usually installed in a single computer. ▸ Updates are virtually non-existent. ▸ Runs on an outdated operating system. NOT SECURE. ▸ You’ll have a hard time moving to a newer CPU or laptop. ▸ You won’t be able to find the developer when you need help.
- 43. ON-PREMISE EMR SYSTEMS CONCERNS OVER EXPENSE =
- 44. IT’S REALLY EXPENSIVE TO BUY THE HARDWARE, OPERATE IT AND MAINTAIN IT.
- 45. MOST PRACTICES DO NOT NEED THAT
- 46. EMR THAT IS CLOUD BASED AND CAN WORK OFFLINE CONCERNS OVER FLEXIBILITY, ACCESS, COST AND CONNECTIVITY =
- 47. IT’S NOT THE STONE AGE ANYMORE
- 48. DESIGN, USABILITY AND EFFICIENCY ARE OF UTMOST IMPORTANCE
- 49. PICK AN EMR THAT FITS YOUR WORKFLOW
- 51. STILL RELATIVELY POOR IN THE PHILIPPINES BY 2018 INFO AND COMMUNICATIONS INFRASTRUCTURE
- 52. IN ICT ACCESS + USAGE (UN INT’L TELECOMM. UNION) THE PHILIPPINES IS 103RD OF 166 COUNTRIES
- 53. DOCTORS MAY BE CONCERNED ABOUT THE EFFECT POOR ICT INFRASTRUCTURE CAN HAVE ON ONLINE EMR’S
- 55. “IS THE DOCTOR’S SOFTWARE SECURE?” PATIENT
- 56. “IS MY DOCTOR PAYING MORE ATTENTION TO ME OR TO HIS LAPTOP?” PATIENT
- 58. DATA PRIVACY ACT OF 2012 (DPA) *In the Philippines
- 59. MOST COMMON ISSUES ▸ Worries over EMR compliance ▸ What is it really for? ▸ More hassle. Stick with paper… ▸ Overall confusion over the Act
- 60. USING PAPER RECORDS? YOU ARE ALSO REQUIRED TO COMPLY WITH THE DPA JUST TO GET THIS OUT OF THE WAY…
- 61. HOW AN ORGANIZATION SHOULD HANDLE OR MANAGE PERSONAL DATA THAT ARE COLLECTED ESSENTIALLY, THE DPA IS AN ACT THAT TELLS YOU …
- 62. YOU SHOULD ALSO “SECURE” YOUR DATA THE DPA ALSO TELLS YOU THAT…
- 65. PROTECT THE DATA SO IT WILL NOT BE LOST OR ALTERED
- 66. HAVE ACCESS TO THE DATA WHEN YOU NEED IT
- 67. BE ABLE TO IDENTIFY WHO ACCESSED YOUR DATA
- 68. PROTECT DATA FROM FLOOD, FIRE, ETC.
- 69. HAVE BACKUPS OR COPIES OF YOUR DATA
- 70. YOU CAN’T DO THOSE WITH PAPER
- 71. HOW MANY TIMES HAVE YOU LOST RECORDS? WHO TOOK IT? WHERE DID IT GO?
- 72. IF YOU KEEP OVER 1000 RECORDS PHASE 1: REGISTER WITH THE NPC
- 73. INDICATE WHAT THE DATA IS FOR AND HOW YOU PROTECT IT PHASE 2: COMPLY
- 74. CHOOSE AN EMR PROVIDER THAT COMPLIES TO THE DPA BEFORE OUTSOURCING TO THEM
- 75. HAVE AN INTERNAL DATA PROTECTION POLICY WITH YOUR STAFF
- 78. WHAT ACTUALLY SLOWS YOU DOWN? ▸ Going through past notes ▸ Trying to understand what you wrote ▸ Write the same set of prescriptions and requests ▸ We write the same letters
- 79. HOW GOING ELECTRONIC WILL HELP YOU ▸ Optimize your workflow ▸ Automate and cut down on redundant tasks ▸ You’ll lessen the consult time (= more patients seen) ▸ BUT you actually spend more time with the patient ▸ Your patient will see the difference
- 81. EVERYTHING ‘NEW’ YOU TRY IS HARD ▸All new things have a learning curve ▸The question should be, how large or small is the learning curve? ▸The software you choose will have a lot to do with that.
- 82. “I SAW AN ARTICLE ONLINE THAT EMR’S HAVE MADE PHYSICIANS QUIT.” DOCTOR
- 83. WHERE IS THE DOCTOR FROM ANYWAY? ▸ Doctors in the US are required to use an EMR and fill up forms a certain way. ▸ It takes freedom away from the doctor and makes them feel like data-entry personnel. ▸ If they don’t fill it up the right way, they wont get paid. ▸ It’s mainly the fault of insurance companies, the government and other policy makers. ▸ The EMR’s should also be designed better to adapt to those changing policies.
- 84. “I READ ALL THESE THINGS ABOUT HACKING…” DOCTOR
- 85. A LOT OF SOFTWARE DO NOT COMPLY WITH ANY SECURITY STANDARDS BECAUSE IT COSTS A LOT OF RESOURCES
- 86. THERE SHOULD BE SECURITY STANDARDS ▸ 256-bit Encryption ▸ United States Health Insurance Portability and Accountability Act (HIPAA) Compliant ▸ Firewalls to Prevent Unauthorized Access ▸ Secure Server Certification
- 87. THERE SHOULD BE ACCOUNT LEVEL SECURITY STANDARDS ▸Secure and strict login rules (and logout rules) ▸Two-factor authentication ▸Access by accounts and roles ▸Track users and what they did inside your account (audit trail)
- 89. BUT… ▸ You can use MS Word ▸ You’re on Facebook daily ▸ You put pictures on Instagram ▸ You chat on Viber ▸ You use Excel to keep track of things ▸ You’re secretly playing Candy Crush right now ▸ And you have the latest phone model
- 90. YOU ARE! I’M NOT THE TECHIE ONE HERE…
- 91. THE ACTUAL BENEFITS ARE WAY MORE THAN THE PERCEIVED CHALLENGES AND BARRIERS
- 92. CAN WE BREAK THROUGH ALL THESE BARRIERS?
- 93. KNOWING RISKS AND REWARDS ▸ If both doctors & patients are better informed, they may be less likely to hesitate... and also have better transitions.
- 94. UNDERSTANDING THE REALITY ▸ No software is perfect for everybody. Software will improve over time. ▸ If it fits your workflow, then you can optimize and double your productivity over time.
- 95. PROVIDING OPTIONS FOR ALL ▸ Offering EMR’s that work both online and offline can help overcome the ICT problems most of the population faces.
- 96. LOWERING ADOPTION HURDLES ▸ Boost provider interest by offering privacy standards compliant, low-cost, user-friendly, adaptable software as it addresses key objections.
- 98. SERIOUSMD.COM IT’S TIME YOU GOT STARTED