how do you solve a problem like an ehr?

How do you solve a

problem like an EHR?

EHR in the primary care setting in the

Philippines

Rene James P. Balandra Jr

MS Health Informatics (Bioinformatics Track)

HI 201 – Overview of Health Informatics

Primary health care

(Declaration of Alma-Ata)

• Reflects and evolves from the economic conditions and sociocultural and

political characteristics of the country and its communities and is based

on the application of the relevant results of social, biomedical and health

services research and public health experience;

• Addresses the main health problems in the community, providing

promotive, preventive, curative and rehabilitative services accordingly;

• Includes at least: education concerning prevailing health problems and

the methods of preventing and controlling them; promotion of food

supply and proper nutrition; an adequate supply of safe water and basic

sanitation; maternal and child health care, including family planning;

immunization against the major infectious diseases; prevention and

control of locally endemic diseases; appropriate treatment of common

diseases and injuries; and provision of essential drugs;

Primary health care


• involves, in addition to the health sector, all related sectors and

aspects of national and community development, in particular

agriculture, animal husbandry, food, industry, education, housing,

public works, communications and other sectors; and demands

the coordinated efforts of all those sectors;

• requires and promotes maximum community and individual self-

reliance and participation in the planning, organization, operation

and control of primary health care, making fullest use of local,

national and other available resources; and to this end develops

through appropriate education the ability of communities to

participate;

• should be sustained by integrated, functional and mutually

supportive referral systems, leading to the progressive

improvement of comprehensive health care for all, and giving

priority to those most in need;

Primary health care


• Relies, at local and referral levels, on health workers, including

physicians, nurses, midwives, auxiliaries and community workers

as applicable, as well as traditional practitioners as needed,

suitably trained socially and technically to work as a health team

and to respond to the expressed health needs of the community.

The Electronic Health Record

• Contains all personal health information belonging to an

individual

• Is entered and accessed electronically by healthcare

providers over the person’s lifetime

• Extends beyond acute inpatient situations including all

ambulatory care settings at which the patient receives

care.

Issues and Challenges

• Clinical Data Entry Issues

– How to translate diagnosis into standards formats in which

resulting data can be analyzed and electronically recorded?

– Lack of familiarity with existing clinical data standards

• Manpower issues

– Lack of Computer Literacy

– Lack of staff with adequate skills

Solutions

• Clinical Data Entry Issues

– Include the health professional in trainings that can enhance

their skills on standards

• Manpower issues

– Capacity building for health care staff

– Use younger and more tech-savvy staff as “force multipliers” in

encouraging and teaching non tech-savvy people

– Use of technological platforms that can be easily taught and

learned by less experienced users


• Strong Resistance to Change by Many Healthcare Providers

– Familiarity to Manual-based systems

– Manual-based reporting systems to comply with

– Double work resulting from implementing both the existing

manual system and an electronic health record system

– Possibility of having an EHR that is different from their usual

workflow

Solutions

• Strong Resistance to Change by Many Healthcare Providers

– EHRs should be able to produce reports compatible with those

required from the health care providers

– Involve healthcare providers in the implementation and design

phase of an HER


• Quality, Privacy and Confidentiality of electronic healthcare

information

– Are outcomes accurately recorded?

– How is the data protected?

– Who can view specific patient data?

– Who can add records?

Solutions

• Quality, Privacy and Confidentiality of electronic healthcare

information

– Privileges should be granted with respect to existing roles in

the current setup of primary care facilities.

– Provide the ability to log and track the addition and update of

patient records as means of accountability.

– Have policies that will serve as guidelines in implementing

EHRs

References

• http://www.who.int/publications/almaata_declaration_en.pdf

• http://www.wpro.who.int/publications/docs/EHRmanual.pdf

THANK YOU!