This document discusses issues and challenges related to implementing electronic health records (EHRs) in primary care settings in the Philippines. It outlines several key challenges including difficulties translating diagnoses into standard formats for electronic recording, a lack of computer literacy and skills among staff, strong resistance to change from healthcare providers accustomed to manual systems, and ensuring quality, privacy and confidentiality of patient data in electronic records. The document proposes solutions such as training health professionals in clinical data standards, capacity building for staff, involving providers in the EHR design process, and establishing policies to guide EHR implementation and track changes to patient records.

1. 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

2. 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;

3. Primary health care (Declaration of Alma-Ata)
•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;

4. Primary health care (Declaration of Alma-Ata)
•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.

5. 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.

6. 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

7. 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

8. Issues and Challenges
•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

9. 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

10. Issues and Challenges
•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?

11. 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

12. References
•http://www.who.int/publications/almaata_declaration_en.pdf
•http://www.wpro.who.int/publications/docs/EHRmanual.pdf
THANK YOU! 