To identify barriers and suggest technology adoption framework in health information system in Nepal

1. Health Information System in the Nepal:
Barriers to the adoption of Electronic
Medical Records
Presented By
Nirmal Kumar Sharma
Acme Engineering College 1
Slides: 25, Estimated time:20 Minutes
Purbanchal University
Acme Engineering College
Supervised By
Prof. Dr. Subarna Shakya

2. Research Problem and Motivation
• At least 44,000 people (and perhaps as many as
98,000) die every year in hospitals, in the U.S, because
of medical errors (Spanjers, 2007)
• In Netherlands, between 1,500 and 6,000 people die
every year due to the similar errors (Spanjers, 2007)
• Specifically, in the Nepal no any research/record found
the rate of Electronic Medical Record (EMR) use in
hospital care (Nepal Telecommunications Authority
Report of ICT Indicators - Nepal at a Glance, INF/25-E
25 September 2012, Page no 10).
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3. Objective
General Objective:
• To identify barriers and suggest technology adoption
framework in health information system in Nepal
Specific Objective:
• To explore the penetration of Electronic Medical
Records in Nepalese hospitals
• To examining the barriers of adoption of Electronic
Medical Record
• To develop framework for adoption of Health
Information System in Nepal
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4. Structure of Thesis
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5. Literature Review
– Costs
– Uncertainty about ROI
– Lack of financial incentives –support
– Lack of Benefits for users who collect data
– Concerns about loss in productivity
– Resistance
– Lack of capacity – technical knowledge
– Lack of coordination and collaboration-lack of leadership
– Lack of adequate IT staff
– Lack of interoperability
– Lack of technical infrastructure-IT requirements
– Lack of standards
– Lack of technical support
– Lack of training
– Regulatory and legal issues.
– Concerns about efficiency and reliability of the system
– Inappropriate disclosure of patient information (all about privacy)
– Concerns about illegal record tampering or Hacking
– Finding an EMR that meet your needs
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6. Research Methodology
• Research Questions:
– Which are the barriers to the adoption of EMR in
Nepalese hospitals?
– What is the stage of HIS adoption in Nepalese
Hospitals?
• Research is quantitative :
– Determined the independent Variables (Barriers of
adoption of Electronic records systems)
– Dependent variable (stage of adoption of
Electronic Medical Records systems)
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7. Research..
• Survey development
– Sample planning: 2.7 % sample size was taken for 95%
confidence level (Cohort sample size calculator, SD=5
and z score 1.96)
– Total hospital (including private hospitals, excluding
health post, sub health post and do not have at least 5
beds hospitals and clinics) is 441 in Nepal (Census
survey: 2014)
– Required sample size 13, to minimize biasness and to
get result more accurate 27 samples were used to
statistical analysis
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8. Sampled District
Research …
Sampled Location:

9. Data Collection
• Data collection was conducted by several
question and answers from public, private and
teaching hospitals of Nepal.
• All the data was collected using Google form,
printed form and email
• 68 questions sets was distributed, among
them 38 were respond where as 27 sets were
used to analysis
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10. Data Analysis
• The analysis of data is quantitative
• In Data Analysis part used IBM SPSS Tools
• Excluded some attributes from questioner as
required.
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11. Clinical Functionalities Record System
1.Electronic Clinical
documentation:
2.Results Viewing 3.CPOE(computerized provider
order entry)
4.Decision Support
i)Patient Demographics
ii)Physicians Notes
iii)Nursing Assessments
iv)Problem List
v)Medication List
vi)Discharge Summaries
vii)Advanced Directives
i)Lab reports
ii)Radiology reports
iii)Radiology Images
iv)Diagnostic Test Results
v)Diagnostic Test Images
vi)Consultant Report
i)Laboratory Tests
ii)Radiology Tests
iii)Medications
iii)Consultation Request
iv)Medications
v)Nursing Orders
i)Clinical Guidelines
ii)Clinical Reminders
iii)Drug Allergy Alerts
iv)Drug-Drug
Interaction Alerts
v)Drug –Lab interaction
alerts
vi)Drug Decision
support
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12. Result
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Basic
63%
Comprehensive
11%
Nothing
26%
Basic Comprehensive Nothing
0-8: Nothing, 8-24: important=basic,
24 and above: Comprehensive
Hospitals that have adopted a basic or a comprehensive system

13. Relation: Stage of Adoption and Lack
of Financial Incentives
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0 2 4 6 8 10 12
neither comprehensive/ basic
basic
comprehensive
number of hospitals
Stageofadoption
Lack of financial incentives
No barrier
Minor Barrier
Major Barrier

14. Relation: Stage of Adoption and Lack
of IT Requirements
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0 1 2 3 4 5 6 7 8 9 10
neither comprehensive / basic
basic
comprehensive
Number of hospitals
Stageofadoption
Lack of IT Requirements
No barrier
Minor barrier
Major barrier

15. Relation: Stage of Adoption and Lack
of Technical Support
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0 1 2 3 4 5 6 7 8
neither comprehensive/ basic
basic
comprehensive
Number of hopsitals
Stageofadoption
Lack of technical support
No barrier
Minor Barrier
Major Barrier

16. Relation: Stage of Adoption and Lack
of IT Training
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0 2 4 6 8 10 12
neither comprehensive/ basic
basic
comprehensive
Number of Hospitals
Stageofadoption
Lack of IT training
No barrier
Minor Barrier
Major Barrier

17. Size of Hospital
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59%25%
16%
Small (1-50 beds)
Medium (50-150 beds)
Large (150 + beds)

18. Relation: Stage of Adoption and Size of
Hospital
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19. Respondent of Hospitals Based on
Their Ownership
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17%
34%
46%
3%
Private/NGO
Nursing Home
Puplic Hospital
Teaching Hospotal

20. Framework: Adoption of Health
Information System in Nepal
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21. Conclusion
• Majority of the hospitals reported financial incentives
as a positive factor regarding the adoption of Health
Information Systems
• 63% of hospitals that have already implemented a
basic system
• IT training identified as a strong influence regarding the
adoption of Health Information System
• Some respondents reported difficulty in finding a
system that meets their needs
• Developed framework for adoption of health
information system in Nepal
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22. Recommendation
• Government may provide interest-free loans
for Health Information implementation
• Training programs free of charge could
support the adoption of EMR especially in
smaller and rural hospitals.
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23. Limitation and Future Work
• Sample Size: Bigger sample could be better
and more reliable
• Variation of Respondent: larger variation of
respondents, form administrative to clinical
staff
• Time frame: advised to capture the time
frame of Health Information System adoption
in order to get a clearer picture of the
adoption process over time
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24. References
• Barjis, J. (2010). ‘’Dutch Electronic Medical Record – Complexity Perspective.’’ Sciences-New York, 1-10.
• Pradhan, J. (2002). Information Technology in Nepal, What Role for the Government? The Electronic Journal on
Information Systems in Developing Countries (EJISDC), 8 (3); 1-11.
• NTA. (2014). NTA: an Introduction. Nepal Telecommunications Authority, Government of Nepal. [Cited 2014
January 19]. Available from: http://www.nta.gov.np/en/content/index.php?task=articles&option=view&id=38
• Yusof, M. M., Kuljis, J., Papazafeiropoulou, A., & Stergioulas, L. K. (2008). ‘’An evaluation framework for Health
Information Systems: human, organization and technology-fit factors (HOT-fit)’’. International journal of medical
informatics, 77(6)
• Vest, J. R., & Gamm, L. D. (2010). ‘’Health information exchange: persistent challenges and new strategies’’. Journal
of the American Medical Informatics Association
• HMGN/HLCIT (2004). Work Manual of Nepali Language in Information Technology/HLCIT.
• The World Bank (2001). Improving Access to Infrastructure Services by the Poor:
• Institutional and Policy Responses prepared by Penelope Brook and Warrick Smith.
• Cetingaya, B. (2009). Telemedicine: A Paradigm Shift in Healthcare. Why Telemedicine might be the Answer? [cited
2010 January 13]. Available from: http://burag.com/2009/12/19/why-telemedicine-might-be-the-answer/
• Braa, J., Hanseth, O. and Heywood, A. (2007). Developing Health Information Systems in Developing Countries:
The Flexible Standards Strategy. MIS Quarterly, 31 (Special Issue); 1-22.
• ITU. (2010). ICT Statistics. International Communication Union. [cited 2010 February 9]. Available from:
http://www.itu.int/ITU-D/icteye/Indicators/Indicators.aspx
• MoH. (2009a). Ministry of Health and Population. Government of Nepal. [cited 2009 September 21]. Available
from: http://www.moh.gov.np/home/country.asp
• ……………………
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25. Thank You!!!
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