Assignment for MSHI 210

1. Issues and Challenges in
EMR in a private clinic of
an Orthopedic Surgeon
Lyndon Bathan, MD
Orthopedic Sports Surgeon
HI201
Thursday, 9-12

2. Data Problems
 Clinical data entry issues and lack of standard
terminology
 In a private setting, where most will enter a standard text
entry, coding it will prove to be difficult if no standard
form or classification system will be followed
 The act of entering paragraphs in a computer might take
more time and in some centers you might still make a
physical chart.
 In orthopedics where we give priority to functional outcomes,
these standard functional scores that can just be ticked can be
used by physician during interview and/or patient while
waiting to save time and also to standardize what is to be
entered in the system.

3. Data Problems
 Concern by providers as to whether information will be
available on request
 In the current state of practice and technology where
everybody is a sms away i.e. any patient from any of your
clinic can ask you a question, the more accurate question
is: Is the information information available
anytime,anywhere and any device?
 The solution is cloud data and mobile access of
information/data in across all operating systems. This is to
facilitate the physicians ability to retrieve data 24/7.

4. Data Problems
 Concerns raised by healthcare professional, patients and
the general community about privacy, confidentiality
and the quality and accuracy of electronically
generated information
 In a a private setting who owns the data? The practioner or
the patient?
 We should be guided by the data privacy act to avoid legal
problems and it will not hurt to also get some kind of consent
if we are planning to use the data in research.

5. Data Problems
 Quality of electronic healthcare information and
accuracy of data entries
 In a a private setting there will be issues of correct data
entries as different end users are entering data from
patient to nurses to doctors?
 At the start or while the system is still being created the end
users must be in the design stage to cater to what they believe
should be in their data or any electronically generated data
from just demographics to functional scores.

6. End User/Support Issues
 Resistance to computer technology and lack of
computer literacy
 Strong resistance to change by many healthcare
providers
 Lack of staff with adequate knowledge of disease
classification systems
 Manpower issues – lack of staff with adequate skills
 Involvement of clinicians and hospital administrators

7. End User/Support Issues
For all the above problems: In a clinic or private
practice where they do not see the benefit of going
electronic, as patients in our country still pay on
out of pocket basis, and there is no need of coding
to bill or to create a study, writing on paper/form
and earning is much easier to learn than to use a
computer, hopefully this is changing with younger
physicians.

8. End User/Support Issues
If there are still employees with computer
literacy problems they should be taught in
seminars or buddy system. While the providers
should be enlightened with the future. Health
Maintenace Organizations are on the rise.
Philippine Health Insurance are now asking for
correct codes to get the accurate payment. Sad
to say earning still holds a big factor to persuade
the uninitiated. For the encoders i.e.
nurses/staff, it is an added skill needed for
future employment/promotion.

9. Other Issues
 High cost of computers and computer systems and
funding limitations
 Environmental issues – electrical wiring and supply
of electricity, amount and quality of space needed
for computers, etc.

10. Other Issues
Not all physicians stay in one clinic except the old
established ones, most have multiple clinics in
different settings, academic, private, rural, etc,
how can the physician maintain his records?
 EMR on handheld devices as most of
professionals or workforce have it have it and
cloud technology. Going mobile EMR is the next
step in EMR and it is just around the corner.