Sri Lanka is well known for its better health indices when compared with other countries in South Asia. However, the burdens of Non Communicable Diseases (NCD) have increased rapidly during last two decades. NCDs such as neoplasms, cardiovascular diseases, diabetes and chronic respiratory pathologies recorded were 10.2, 41.7, 13.3 (related deaths per 100,000 population) respectively during the year 1990. However by 2009, the same NCDs recorded 18.5, 60.6, and 21.9 (related deaths per 100,000 populations) respectively according to the Annual Health Bullatin released by the Medical Statistics Unit - Ministry of Healthcare & Nutrition [1]. Most communicable diseases have been controlled successfully (e.g. Malaria, Polio) several infective diseases, such as, Tuberculosis and Leprosy has been re-emerged due to various reasons. Dengue is also still remains a major crisis in Sri Lankan health sector. Health Information Systems have been shown an integral role in health systems in facing double burden of disease, specially quantifying the cost of care. Also, Health Information Systems are one of WHO's 6 building blocks for health system strengthening. This work investigates the Sri Lankan scenario empirically based on selected electronic health information systems to evaluate the effect of reducing uncertainty and promoting coordination in the clinical care pathway.

1. IMPACT OF ELECTRONIC HEALTH RECORDS IN SRI
LANKA: CASE STUDY OF GOVERNMENT HOSPITALS.
SHRIyananda Rathnayake
Programme Manager – ICT Agency of Sri Lanka

2. Background
• High life expectancy of 77.4
• Low rate of maternal mortality (41.6 per 100,000 live
births)
• Low rate of infant mortality (8.5 per 1,000 live births)
• Over 89% of the population has access to safe drinking
water
• 85% of population has proper sanitation facilities
BUT
 The burden of Non Communicable Diseases (NCD) have
increased rapidly during last two decades
 Communicable diseases such as Tuberculosis, Leprosy,
Dengue is on the rise due to environmental and social
factors

3. Why EHR
• Total health expenditure in Sri Lanka is recorded as
between 3.4% and 3.7% of GDP
• Contribution from government to health care
expenditure 47%.
• Contribution from Private sector 53%
 80% of out-of-pocket expenditure
 20% of Insurance, non profit activity contribution
Private sector is expanding further, outpatient care
and medical laboratory services
Patients accessing healthcare services in an ad hoc and
piecemeal fashion owing to cost of care

4.  NCDs are chronic in nature and demand systematic
treatment protocols being adopted in disease
management.
 Poor management of such diseases leads to worsening
health condition
Government Health -OPD settings
• Long Queue
• Maximum 2 minutes per patient
• No time to ask patient history
• No health information,
• Long stay to access the health care
Why EHR

5. 2010 2011 2012 2013 2014 2015 2016 2017
EHR
implementation
kick off.
HHIMS v.1.0
Dr. A.I Jagoda
Dr. K.N.G
Senevirathne
Lunar Technology
Karawanella B.H
HHIMS v 1.1
Dompe D.H
HHIMS v 1.2
(Beta)
Queue
management
system
Dr. Sampath
Kulathilake
HHIMS v 1.3
Release
Stable Version
Dr. Sampath
Kulathilake
Dr. Yasith
Mayabandara
HHIMS v 1.4
Awissawella
Base Hospital
Dr. Pradeep
KeerthiMallawa
Dr. Shantha
Senevirathne
Dr. Sampath
Kulathilake
Nipun Sachindra
HHIMS v 2.0
Base hospital
Panadura
(2014)
HHIMS v 2.0
and HHIMS v
2.1
(will be
release soon)
HHIMS v 3.0(Cloud Based)
Android App and mobile
devices for Ward Round
National DB for Patient
Registration (Central PHN
Registration)
Dr. Clive James
Dr. Sampath
Kulathilake
Dr. Yasith
Mayabandara
Dr. A.I Jagoda
History and Versions

6. What is HHIMS
HHIMS is Free and Open Source Hospital Health Information Management System specially
designed for the requirement of Sri Lankan hospitals. HHIMS comprises Electronic Medical
Record (EMR), Computerized Provider Order Entry (CPOE), Pharmacy Management, and
Laboratory Information Management.

7. Research Settings
• Research Question - To what extend adaptation of electronic
health records improve the quality and efficiency in government health
care services
• Research Sample - Dambadeniya, Mahaoya, Awissawella Base
hospitals and Dompe District Hospital.
• Survey Method – Mixed Method, (Qualitative and Quantitative
Method)
• Data Collection Techniques - Questionnaire, Focus Group
Discussions (FGDs) and Key Informant Interviews (KIIs). Telephone
interviews
• Respondents - Medical staff and health care services staff at
hospitals, Patients and individual beneficiaries.

8. Research Focused
• Levelof awareness of information system
• Level of usage of information system
• Whether or not users believe that there are benefits from
HIS
• Whether the users are aware of the benefits of HIS
• Whether the users believe that the HIS is sustainable
• Critical success factors according to the users views
• Negative impacts if any form due to HIS
• Usability and operational difficulties
• Awareness on Organizational benefits and challenges in
use of HHIMS

9. Results
81%
3%
59%
22%
35%
19%
Hassel free quality and
speedy health service
Can make advance
appointments now
No need to repeat our
details
Accurate diagnosis
Enhanced care by the
doctors
Appropriate management
plan for the patients

10. Results
 93% of the patients have mentioned that they think it is
beneficial for them to get services from hospital which
has a HIS.
 Among them 79% experienced reduction of waiting time
for health care services
 59% believes that HIS enhanced quality of health service
since the records will be reviewed by other doctors in a
future day when the same patient visits the hospital
 93% of the patients believe that there are no negative
impacts and only 7% have said there are negative impacts
due to the failures of the system.

11. Usability and operational acceptance play a major role in
implementing the HIS in any health care institute
 88% of system user rate the HIS as “easy and user-friendly” 99% of
the system users are familiar with the system.
 94% of system users believe that they are benefited through HIS
implementation
 70% of health care staff believes that the HIS implementation
resulted reduction of patient waiting time
 52% mentioned that it is also pave the path for hassle free
healthcare services.
 More than 50% of health staff mentioned that availability of
electronic medical records create an environment to improve the
quality of care by health staff.
Results

12. Limitations of research
 Themedical staff, nurses and pharmacists at the
dispensaries were extremely busy throughout the day
 Three hospitals have implemented the HIS (HHIMS) only
in OPD and clinics sections and only Dompe district
hospital implemented the system covering inward
section
 system implementation in clinic section also limited to
few clinics such as family medical clinics.

13. Photo Story

14.  Needs a bit of a computer literacy.
 Need a bit of English Knowledge (esp. Registration
Desk staff ).
 Need the supervision of a IT admin
 Power failure solution is needed.
 Difficult to use in extreme weather(thundering)
Drawbacks

15. • Health Information system implementation in
government hospitals will lead to quality and
efficiency improvement of the health sector in Sri
Lanka.
• More empirical research to be conducted to
measure the outcome and impact
Conclusion

16. Q & A