At the centre of good e-Health practice is the Electronic Health Record (EHR). We have witnessed a lot of discussion around Telemedicine and mHealth services but to fully unpack the benefits of eHealth we have to also mature electronic patient information systems.
The Ministry of Health is implementing the SAP Healthcare application for its central hospitals. As a result, Chitungwiza Central Hospital is on a sure path towards paperless operation.
However, EHR adoption and utilization is still low in the many GP practices, specialist rooms, clinics and hospitals in the private sector.
I’ve had the pleasure of working with several local entrepreneurs at different stages of development of their medical practice management applications in a rush to meet this gap in the market.
Recently, the leading SAP player in Zimbabwe, Twenty Third Century Systems assumed the lead. At a lavish breakfast meeting in Harare, its subsidiary, DBS, unveiled their new product called MedicalOne.
Built on the backbone of SAP BusinessOne, MedicalOne is a medical enterprise solution that is said to be specially crafted for small to medium sized medical institutions.
We can expect to see other EHR developers and vendors following suite. I’m always impressed by how much each developer’s EHR solution is different. Some are good, some are better. Some have more, some have too much.
For the effective adoption of electronic health information systems over the less convenient paper based status quo, there are key functionalities that every EHR system on the market should have. One bad apple can really spoil the whole bunch.
During these early stages of eHealth adoption, a negative encounter with an EHR solution can fuel the unnecessary scepticism that is slowing progress.
Here are 10 things that EHR developers should consider when preparing solutions especially for the Zimbabwean market.
1. User experience.
The American Medical Association conducted a survey that reported just 34% of doctors were satisfied with their EHR systems. Other studies have also sited EHRs among the top 10 causes of doctors’ experiencing burnout. With these studies in mind the user experience cannot be side-lined. The design and workflow of the medical enterprise software shouldn’t unnecessarily contribute to the high workload that doctors already have. Writing clinical notes is already a tedious and mundane activity which is why doctors’ handwriting is witchcraft! Therefore EHRs should be designed to relieve that stress. The EHR should be able to capture relevant clinical information intuitively through features such as auto-transcript or voice dictation. Another solution is incorporating handwriting recognition features. Any doctor would love that!
2. Standard architecture
Standards are necessary for interoperability. We are yet to have eHealth standards enforced by legislature however there are established international standards of architecture that can be adopted. Recommended examples are the Clinical Document Architecture (CDA) and Continuity of Care Document (CCD) used in the US healthcare system. They can be adapted and adopted for our setting. This ensures that as a patient is being reported from one healthcare system to the next, the information is communicated in a ready for use format.
3. ICD-10 vocabulary
Another important standard necessary for interoperability is using the same health coding system for naming and classifying diseases. Although, there are various coding systems available, in Zimbabwe we are adopting the International Classification of Diseases – 10th version (ICD 10) which was developed by the WHO. Therefore it is recommended that our EHR systems be developed with ICD-10 integrated.
4. DHIS-2 compatibility
The benefit of electronic health information systems is their ability to track individual and population health problems and treatment over time. This enables us to timely identify and respond to disease outbreaks. The Ministry of Health adopted DHIS-2 as the national health information system for collection and analysis of routine health services data. To prevent data silos and blind spots arising in the private health sector it is important that all EHRs be able to contribute to the ministry’s DHIS-2 system.
5. Clinical Decision Support Features
A game changer for the local EHR market would be an intuitive system that is able to assist doctors in their day to day clinical decision making. An example is a system able to identify harmful drug to drug interactions as the doctor is typing their prescription. Or a system that has clinical treatment guidelines inbuilt to assist doctors treat patients according to the latest evidence based medicine.
6. Patient access
Patients have a right to access information about their own health and treatment at any time. EHR systems should have a patient portal in accordance with this right. It would be notable to go a step further and develop a Patient Health Record (PHR) that allows the patient to have a longitudinal track of their treatment. This they can use when transferring to a different healthcare system. Considering the rise of medical tourism this is extremely valuable. Granting the patient access to the system is of great advantage in the management of chronic diseases such as diabetes and hypertension. Patients can then be enabled to upload self-recorded measurements of blood pressure, weight or blood sugar for the doctor to monitor. With the rise of connected health devices and wearables, EHRs should be designed to incorporate these.
7. Mobile access
For convenience the EHR system should grant mobile access. The dictum “Think mobile first” abides here.
8. Privacy and security
For ethical reasons privacy and security have to be at the heart of the EHR system development. Considerable investments have to be made towards securing the system. One notion that many senior doctors are preoccupied with is the issue of “hackers.” The task is to really prove that the system is safe from hackers. EHRs should have appropriate tiers of login access enabling a supervisor to monitor who has entered, viewed and altered any information.
9. Customization of reports
Medical practices are different from other enterprises so financial reports alone are not sufficient. Each medical practice is different from the next depending on the specialty of the doctor. EHRs should cater to the individual needs of the practice and be able to prepare unique reports. Game changers would be reports that can facilitate medical research through analysing disease and treatment outcome trends.
10. Medical Aid society tracking
There is an ongoing war between healthcare providers and healthcare fund managers in Zimbabwe. Doctors are really desperate for solutions that will enable them to electronically submit claims, check policy validity and reconcile amounts paid and owing.
The above list is certainly not exhaustive. As a country we are lagging behind in adoption of eHealth systems. This however presents us the advantage of learning from the mistakes of those that have gone before.
We should develop EHR solutions that provide greater user satisfaction and allow for interoperability. Legislature backed standards for electronic health information systems are essential. We can benefit from having a similar model to
We can benefit from having a similar model to US Office of the National Coordinator for Health Information Technology (ONCHIT) which certifies EHR systems. ONCHIT also provides financial incentives for medical institutions that install EHR systems. This would really catalyse the TechMedicine revolution.
The race for the medical practice management software market continues. May the company with the best EHR product win.
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