Downloaded 79 times
Uploaded byM H Buddhika Ariyaratne
Electronic health record system for sri lankan general practitioners
The document discusses the integration of electronic health records (EHR) into general practice, outlining their definitions, components, benefits, and concerns. It emphasizes the importance of EHR in improving patient safety and efficiency while identifying barriers to adoption, such as costs and technical challenges. The future of EHR is envisioned to include better interoperability and patient collaboration.
More Related Content
Similar to Electronic health record system for sri lankan general practitioners
More from M H Buddhika Ariyaratne
![Rheumatic Fever CASE PRESENTATION [Autosaved].pptx](https://cdn.slidesharecdn.com/ss_thumbnails/casepresentationautosaved-251123182512-9d9b0da4-thumbnail.jpg?width=640&height=640&fit=bounds)
Electronic health record system for sri lankan general practitioners
- 1. Dr. M. H.B. Ariyaratne
- 2. Background • I waspracticing as a GP • Can I use IT for my practice? • Yes, Electronic Health Record Systems available. • Future of General Practice is going to be shaped by ICT
- 3. What is anElectronic Health/Medical Record? • An electronically available record of an individual's health and care history • EMR : An electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one health care organization. • EHR : An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff across more than one health care organization. • PHR: An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared, and controlled by the individual.
- 4. Information Included • Demographics •Presenting Problems • Medication • Allergies • Laboratory Results • Radiological Findings
- 5. Components • Order Management •Decision Support • Electronic Communication • Patient support • Administrative Processes – Scheduling – Billing – Insurance • Reporting
- 6. Benefits of EHR •Improved patient safety • Avoid poor penmanship errors • Minimize adverse drug effects • Better patient notification • Timely, accurate health data • Rapid sorting of available information • Knowledge bases • Decrease cost on long run
- 7. Concerns with EHR •Over reliance • Privacy, Confidentiality & Security Issues • Legal Issues • Unavailability due to technical problems • Potential malpractice liability
- 8. Options for SriLanka GP • Not think of using a system for ever – No, I want one • Use an existing EHR system, most probably developed for other country – Downloaded – Tried – Not matching my requirements – Overloaded with dispensable functionality
- 9. Options for SriLanka GP … • Wait till the best solution is “invented” – But how long? – Who will develop it? • Develop one from scratch – Expensive – Time consuming – Poor domain knowledge to analyzers & developers – GPs have
- 10. Achieved • Needed tocope up with patient overload • Minimal interaction between the doctor and the computer • Maximize time for doctor patient relationship • To generate prescriptions faster than writing them by hand • Without loosing functionality of an EMR system
- 11. Flow of theActivities Patient Comes to Clinic Receptionist Search patient Add NewSelect Receptionist Add patient to queue Doctor take patients from queue Manage Encounter End Has a Receptionist Start Patient Found Yes No Yes No Doctor Search patient Add NewSelect Patient Found Yes No
- 12. Manage Encounter StartEncounter EndEncounter End Start Billing View PreviousVisit Details Refill Educate Patients Issue Medical Certificates Generate Referrals Records Procedures (TT, DMPA injection, C&D) Order Investigations View /Edit patient data (Demographics, Allergies, PMH) Record Clinical Features Prescribe
- 13. Speeding up theprescriptions
- 14.
- 15. Patient Window forreceptionist
- 16.
- 17.
- 18.
- 19.
- 20.
- 21. •Freely Downloadable www.lakmedi.com •Minimal Hardware Requirements Barriers tothe acceptance of EMR systems • Financial – start-up costs – ongoing costs. • Technical – Physicians and/or staff lack computer skills – Lack of technical training and support – Complexity of the system – Limitations of the system – Lack of customizability – Lack of Reliability – Interconnectivity/Standardization – Lack of computers/hardware •Easy to Learn •Simple•Covers most of the functionality needed by a Sri Lankan GP •Can be customized to match different needs
- 22. Barriers to theacceptance of EMR systems • Time – Time required to select, purchase, and implement the system – Time to learn the system – Time required to enter data – More time per patient – Time to convert patient records • Psychological – Lack of belief in EMRs – Need for control Easy Installation Easy to Learn Easy to Enter Data Less time needed to spend with computer
- 23. Barriers to theacceptance of EMR systems • Social – Uncertainty about the vendor – Lack of support from external parties – Interference with doctor-patient relationship – Lack of support from other colleagues – Lack of support from the management level • Legal – Privacy or security concerns Less time to interact with computer
- 24. Barriers to theacceptance of EMR systems • Organizational – Organizational size – Organizational type • Change Process – Lack of support from the organizational culture – Lack of incentives – Lack of participation – Lack of leadership
- 25. Areas of Concern •Documentation • Support • Community
- 26. Future • Interoperability • Betterhuman interfaces • Patient collaboration • Distributed • Clinical decision support
- 27.
- 28. References • http://www.scribd.com/doc/55267278/Lesson-5-Electronic-Health- Record-and-Clinical-Informatics-ppt-Student-Copy • http://www.emr.msu.edu/Documents/ppt/Why%20Use%20an%20EMR _files/frame.htm •http://www.emr.msu.edu/Documents/ppt/The%20EMR%20Literature- Benefits%20of%20Use_files/frame.htm • http://www.srhdb.org/index.php?option=com_content&view=article&id =113&Itemid=202&showall=1 • http://www.biomedcentral.com/1472-6963/10/231 • http://ed-informatics.org/healthcare-it-in-a-nutshell-2/emr-vs-ehr-vs- phr/ • http://www.emr.msu.edu/Documents/ppt/The%20EMR%20Literature- Benefits%20of%20Use_files/frame.htm • Privacy: one’s right to control who has access to information about oneself • Confidentiality: a duty owed by one to preserve the secrets of another • Security: mechanisms put in place to safeguard privacy and ensure confidentiality is maintained
Editor's Notes
- #2 Good morning all, I am Dr. M H B Ariyaratne, a trainee for MSc(Biomedical Informatics) at the postgraduate institute of Medicine. Thank you very much for your participation for this e-health session. This morning I would like present an Electronic Medical Record System for Sri Lankan General Practitioners.
- #3 Sometime back I was practicing as a part time GP. Inspired by the penetration of Information technology to fields like Banking and Marketing, I was thinking whether there was any possibility to use IT for my practice as well. With some googling, I came to know that there is a concept named Electronic Medical Record. I understood that it is only a matter of time before the Information Technology been extensively utilized in general practice. I also read about the fascinating future of the General Practice shaped to new innovations related to ICT. The patient may be coming with a smart card which contain the complete history and genetic profile, which will be utilized in the diagnosing and management with the help of decision support systems. If expert opinion is needed, telemedicine will come in to play. Patient monitoring and alerting will be done by the system. So why wait, I wanted to start the adaptation straight away.
- #4 Moving in to some technical stuff, What is an Electronic Medical Record? There are various definitions, but basically it is an electronically available record of an individual’s health and care history.
- #5 Information included in an EHR includes, but not limited to, patient demographics, presenting problems, medication, allergies and so on.
- #6 EMR system may contain several components like order management, decision support, electronic communication, patient support and etc. etc.
- #7 As displayed, numerous benefits of using an EMR system have been identified over the old paper based patient management system by several studies.
- #8 There are controversies, debates and disagreements, but no system is devoid of these issues.
- #9 So as a GP, I had few options regarding the use of EMR system. I could have given up the whole idea, but that was not my choice. I downloaded few available free EHR systems or Demo versions and tried it my self. What I felt was that they are not ment for me, that is an average GP of our country. The requirements were different, for example, there is no concept like indoor medicine or out door medicines, which is commonly used in general practice in Sri Lanka. There were lot of high end functionalities like insurance billing which were not needed for me.
- #10 Certainly I could have waited till a so called optimum solution is developed by some one, but there were no guarantee and a possible time frame. So I started developing my own, with the help of several, including some GPs. And I think the effort has added another option for other GPs.
- #11 The end product, in essence, is a system that need minimal interaction with the computer to maximize the time available for doctor patient relationship in a busy practice without loosing the functionality of an average EMR system.
- #12 This diagram shows the basic flow of the activities of the system. In a practice where there is a receptionist with a computer, she add patients to a queue as they come. The doctor take patients one by one from the queue. When there is only one computer, the doctor himself can start a new encounter without the need of a queue.
- #13 The program can be used in various ways to manage an encounter between the GP and the patient. Some may straight away generate a prescription and close the encounter. Some may add clinical data related to this encounter or change the semi permanent data like medical history. Ordering investigations and viewing available results can also be managed by the system. Auto generation of referrals and medical certificates are also added as features.
- #14 I will show one way that is used to speedup the generation of prescriptions. The doctor take a patient from the queue, two clicks. The new visit window will appear with the focus on the problems or the diagnosis dropdown. Focus on the patient after that small interaction with the computer. Take the history and do the examination and come to a working diagnosis taking all the time available, and return to the computer just to type first few letters of the workout problem and press enter. The result will be generation of a list of medicines, which were configured at the onset only once, appearing according to the weight, if given, or the age. If there is no need to change the combination, clicking the print button will generate the prescription and save the details.
- #15 I will display some more screen shots of the system. This login screen make sure the correct person can only access the system and the privileges will be granted depending on the role the user play. Unlimited number of user accounts with different privileges can be added by administrator.
- #16 This window is meant for the receptionist who only select or add a new patient with basic demographic data and lineup in the queue to be seen by the doctor.
- #17 This is the detailed patient window meant for doctors. All the patients are listed by their name on the left side of this patient details window. Patients can be also be searched by parameters like address and birthday as well. When a patient is selected, the details are displayed on the right side. Past visits and their details, history, investigation results, allergies, and images are also accessible within the same window. New patients can also be added in the same window.
- #18 This is the window where encounters are managed. Basic demographics details, brief history, past visit details and stocks in the prescribed medicines can be viewed within the same screen. The problems, investigations requested, visit comments, Blood pressure and weight can be entered without navigating out of this window. There are links to access full patient demographic details, history and detailed clinical feature records. The links are also available to generate referrals or certificates, to store images and to manage billing.
- #19 This is the window where referrals are generated automatically, which can be edited and printed.
- #20 This is the window where medical certificates are generated.
- #21 This is the window where clinical details can be recorded and viewed.
- #22 Several barrier have been identified by some studies done in other countries. This system have tried to overcome some of those barriers the following ways. The startup cost is less as this software is freely downloadable over the internet and needs very basic hardware requirements. System is easy to learn even by the users with average computer literacy. The advanced features have been masked in the development of the user interface to remove the complexity. Most of the functionality expected by the system by a GP in the country is incorporated to the system. The software is extensively customizable to match the different requirements of different setups.
- #23 Barriers due to the necessity to spend additional time on the software is minimized by the use of several innovative methods to generate prescriptions fast as described earlier.
- #24 As less time is spend on the computer, there is virtually no interference with the doctor-patient relationship.
- #25 But there are several barriers that can not be overcome by development of a system. The success of an implementation of a system depend on several factors including the support from different organizations.
- #26 This main short comings of this system include poor documentation, lack of support and unavailability of a community to sustain the system.
- #27 In addition to overcome the above defects, the future plans include addressing the issues like interoperability, making it a distributed application with multi-tire architecture and addition of new features like clinical decision support and better human interfaces.
- #28 It is very difficult to explain an EHR system properly in this much of a short period of time and all what I did was a mere introduction. If you have any questions, I’ll be happy to answer them at the end of the session. I will also be available in the HISSL store during the breaks. If you are interested, download and install and try it yourself. Please feel free to contact me for any clarification. Thank you.