Implementation an electronic medical record in community hospital in Thailand: In search for best practices

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Fri, 05/23/2008 - 01:50 — admin

Implementation an electronic medical record in community hospital in Thailand: In search for best practices
Supachai Parchariyanon, MD, BBA

Increasing awareness and rising demand for better healthcare facilities are driving adoption of various forms of information systems in healthcare organizations throughout the world, Thailand is one of the countries that is in the same situation. Based on latest data from ministry of public health reported in 2004, we have 1,287 hospitals nationwide, 875 (68.47 %) of them are public hospitals, 298 (23.31 %) of them are private hospitals and the rest 105 (8.22 %) are public hospitals that are not report to ministry of public health. Of those which are public hospitals, 723 (82.63 %) of them are community hospitals which have less than 150 beds each, 70 of them are general hospitals which have less than 500 beds each and 25 of them are center or university hospitals which have more than 500 beds each [1].

I’ve experienced myself practicing in 60 beds community hospital, 400 beds general hospital and 2,600 beds university hospital and found out that these hospital shared very common informatics related problems, the differences are all about their complexities. One example is that when the walk-in patient that was once registered in the hospital come to the hospital for annual check-up, the medical record department of community hospital could not find his paper-based medical record, they just issued the new medical record and at the same time created the duplication of medical record, the same situation occurred in university hospital, but instead of issued the new medical record right at the beginning they have to enter to the medical record archiving room which stores roughly 2,400,000 medical records to make sure they will not create another duplicate one, moreover, they have to log-in the another systems to check whether his medical record already scanned into digital images if the answer is yes, they can print out his medical record without creating the duplication. There are other common problems such as only one person is able to access paper-based medical record at a time, the data is disorganized, incomplete or insecure, doctors’ hand writing are too hard to decipher and leading to medical errors that harm patient safety. [2]

The only way to get rid of those problems is to implement an electronic medical record that is included computerized physician order entry system and how we can achieve that, what are the best practices, I’ve reviewed books & research articles and found Lynne S Nemeth stated that the following concepts elaborate the process of how change occurred within these practices:
1. Vision with clear goals
2. Team involvement
3. Enhance communication systems
4. Develop staff knowledge
5. Take small steps
6. Assimilate electronic medical record (EMR) into clinical practice to maximize clinical effectiveness
7. Feedback within a culture of improvement [3]

Another research from Amanda L. Terry stated that Four common themes arose from the 3 studies: expectations of EHRs, time and training required to implement and adopt the software, the emergence of an EHR champion or problem solver, and the readiness of health care providers to accept the system. [4]

I would like to simplify it this way by grouping them in 5 concepts as follow
1. Sponsorship from management
Not only vision but clear goal of what we are going to do, how it will be benefit to our organization and what expectation that everyone might have.

2. Team involvement
Let’s everyone get involve since the beginning, they will feel they own the project and would like to make it successful, don’t forget to find the stars or champions in the project, these people are helping the project solving day-to-day operations during implementation and post production.

3. Change management
Enhancing internal communication and managing training activities while implementation takes place to make sure that everyone moving together as a team. Anyway, when making changes in practice, taking small steps implies motivation is present within the practice and willingness to test a small change.

4. Add it into clinical practice to maximize clinical effectiveness
Embedding evident-based guidelines into practice to make the most of EHR.

5. Feedback within a culture of improvement
Set up regular review and feedback session to make this motivating everyone throughout the implementation phase.

In conclusion, I only bring up key success factors to implementation EHR in Thailand which may not different from other countries around the world but yet this is very conceptual and need more in-depth research and project management methodology in order to answer the whole question about best practices in electronic medical record implementation.

References
1. Office of permanent secretariat of Ministry of Public Health http://203.157.240.12/bie/index.php?ch=iop5
2. Dick, R., Steen, E., et al., eds. (1997). The Computer-Based Patient Record: An Essential Technology for Health Care, Revised Edition. Washington, DC. National Academy Press.
3. Lynne S Nemeth, C. F., Gail W Stuart, and Steven M Ornstein. (2008). "Implementing change in primary care practices using electronic medical records: a conceptual framework." Implement Sci 16.
4. Terry AL, T. C., Giles G, Brown JB, Harris SB, Reid GJ, Thind A, Stewart M. (2008). "Implementing electronic health records : Key factors in primary care." Can Fam Physician 54: 730-6.
21 May 2008

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Sun, 08/02/2009 - 14:27 — thopmermorb
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Sun, 08/02/2009 - 12:09 — Assistiah
ImmergyRecy

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Sun, 08/02/2009 - 10:54 — FauroBoulkFuh
Estisonnenugs

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Sun, 08/02/2009 - 10:30 — Plaippept
agettewanda

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