A Report

on

Acceptance of Primary Care EHR by the Doctors

at

dWise Healthcare IT Solutions Pvt. Ltd, Bangalore

Submitted by

Dr.V.Dhanalakshmi,BPT

of

Post-Graduate Diploma Management in Healthcare Information Technology

PGDM-HIT 2015-17 Batch

As a partial fulfilment of the Summer Training Program requirement

of PGDM-HIT Program

(April 2016 to June 2016)

1

Certificate

This is to certify that Dr. V. DhanaLakshmi. BPT, Registration No

IIHMR-B/PGDM-HIT/2015-17/144, student of Institute of Health Management

and Research, Bangalore has successfully completed her internship project titled

“Acceptance of primary Care Her By the Doctors” in our organization dWise

Healthcare IT solutions Pvt. Ltd. from April-05-2016 to June-05-2016.

Signature of the Industry Mentor

2

Certificate by the Faculty Mentor

This is to certify that Dr.V. DhanaLakshmi BPT, Regn. No. IHMR-B/PGDM-HIT/2015-

17/144 has done the project on “Acceptance of Primary Care EHR by the

Doctors” under the supervision of Dr. Pramod at dWise Healthcare IT solutions Pvt.

Ltd. as a partial fulfilment of the Summer Training Program requirement of PGDM-

HIT Program (2015-17 Batch).

Signature of the Mentor Signature of Dean - Academic and Student Affairs

Dr. R. Sarala (Dr. Usha Manjunath)

3

Acknowledgement

On completion of my Summer Training Project, when I look back on the whole experience

from its very start, I feel humbled. All along I was assured of the presence of Almighty, to

whom goes all the glory, for successful completion of the Project. At the outset, I want to

express my deep gratitude to my guide and mentor Dr. Sarala, Assistant Professor at

IIHMR-Bangalore, for her support and timely guidance in helping me complete the study.

My heartfelt gratitude to my Industry Mentor Dr. Pramod D Jacob and Mr. Ramesh Sharma,

who rendered their valuable advice, precious time, knowledge and experience on the

domain and whose suggestions and guidance have immensely helped me in completion of

this Summer Training Report. I would also like to thank each and every employee of dWise

Healthcare IT Solutions, for their love and support throughout the summer training

programme. Their suggestions and guidance have been of great learning value.

My sincere Thanks to one and all!

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Table of Contents

Chapters Title Page Number

1. Organization Profile 1-6

2. HMIS 7- 13

3. Implementation 14-21

4. Primary Care HER 22-25

5

Acronyms/Abbreviations

EHR Electronic Health Record

HIT Health Information Technology

ER Emergency Room

ICD International Classification of Diseases

LOINC Logical observation Identifiers Names &Codes

NANDA North American Nursing Diagnosis Association

CDSS Clinical Decision Support System

CPOE Computerized Physician Order Entry

CCR Continuity of Care Record

CCD Continuity of Care Document

CDA Clinical Document Architecture

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Executive Summary

This report is compilation of all the assignment that is undertaken during the

Summer Training. The report presents in detail about the Hospital Management

Information System (HMIS) and Implementation Process of dwise Healthcare. In

addition, Primary Care EHR Management Software of dwise is discussed in detail.

As part of summer training, a study was carried out a) to understand the

acceptability of Primary care EHR by doctors (Bangalore) in clinics and reasons for

adoption and non-adoption of it. Interviewed schedule was developed and was

incorporated in the mobile app was used to collect the data from the respondents.

Convenient sampling was adopted to collect the data since; the list of clinics was not

available. Total number of doctors’ interviewed was 100. Findings of the study

revealed that a large number of (80 %) of the doctors are willing to use the primary

care EHR and are already using software. During the interview the doctors were

saying that they like to use the software since it reduces the treatment time, errors,

increase the quality of the treatment and can maintain the patients’ record for long

time and all the information about particular patients can be kept from the time of

birth. Reasons for non-adoption of EHR Software by doctor were a) Senior doctors

who are more than 60 years of age they rejected (1 out of 2) because they said they

are happy and comfort with traditional way of writing on paper b) Consumes time

since need to type the information clicking on respective tabs c) Doctor- patient

Interaction will be hampered/less attention to complaints shared by the patient and

d) Maintaintence of the internet speed is not possible. Other During visit many

clinics are not having proper infrastructure such as computer, internet connectivity

and proper setup of their clinic. Thus, it is recommended that a) Usage of EHR

Software can be increase by providing low internet speed and less set up by

software companies b) If that EHR software is more User-friendly then usage will

be more and c) EHR Software usage can be increase by initiative taken by

Government of India like tax reduction for EHR software using hosp

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Chapter I

Profile of the Organisation: dwise Healthcare Solutions

1.1 History of the Organisation

dwise Healthcare Solutions as Healthcare Domain Experts with a collective experience of

more than 100 Man years in the areas of Healthcare IT Software Development with

expertise in Cloud Engineering, Big Data & Analytics and Mobility solutions. They operate

with dedicated focus on EHR Technology Framework and have experience in developing

and deploying Healthcare IT products in highly competitive International Markets. They

developed a Cloud based Ambulatory EHR Solution for Primary Care and a complete

Inpatient EHR solution for Hospitals, for the US Healthcare industry, which received

“Meaningful Use (MU)” Stages 1 & 2 Certification. They also developed other Cloud based

products for the US Healthcare market such as a Financial Management Solution, a

Physician Credentialing Platform and a Geriatric Care Management product. Their products

are built on modern technology, comply with International and Indian EHR (Electronic

Health Records) standards. They have innovative company finding success and satisfaction

in being able to work closely with our clients in areas that are critical to their success. They

strive to support customers with best practices in Healthcare Management through the

domain & technology expertise and mature Healthcare IT Software Solutions. Their

solutions focus on customer delight. They are very nimble footed when it comes to speed of

implementation and they take great pride in being a thinking organization. They see each

engagement as an opportunity to collaborate with their clients and ensure maximum

return on their investment.

Vision

Lifetrenz was set up with the vision to become the leading provider of innovative and

economical Healthcare IT Solutions to help healthcare providers deliver safer healthcare

while bringing down the overall cost. Our Vision is to become the No.1 EHR Solution

provider in India by 2018.

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Mission

Constantly upgrade the technology and capabilities to address the evolving needs of the

Healthcare IT market by deploying best of breed technologies, people and domain

expertise aimed at enhancing the operational excellence of Healthcare organizations on the

LifetrenzPlatform.

1.2. What They Do

dwise build IT solutions that enable healthcare providers deliver safer healthcare,

economically, so as to make quality healthcare more affordable for people across all socio-

economic strata. The service, delivered as pay-per-user service, from public cloud platform

enables healthcare providers of all sizes and segments to consume these services as they

need. dwise service sits on top of an extensive and evolving knowledge base of information

and tools that enable the users of the service to improve the safety, quality and speed of

their work. Any professional person or organization in healthcare wishing to streamline

their practice and align their work to International Standards and best practices will find

that Lifetrenz makes this journey painless. Though there are many local and regional

players in this segment, it is largely fragmented and looked at more from an operations

perspective and not so much from the clinical delivery of care perspective. Lifetrenzturns

the table around to look at the whole solution from a patient centric perspective and makes

it possible to capture, store and retrieve patient clinical data using EHR standards. The EHR

Technology Framework of Lifetrenz is built on Open Source Technologies incorporating

features like scalability, exceptional all round security and minimal set-up and go-live

requirements, blending best of functionality with user-friendliness.

1.3. Location of the Company

dWise Healthcare  is located only in Bangalore .

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1.4. Service Provided by the Organization

dwise mainly provides HMIS software and EHR & Clinical Information System (CIS) which

address the Clinical, Operational, Financial and Administrative workflows of a Hospital.Itis

a patient centric & standards compliant Hospital Management System, that is highly

configurable to provide automated, end to end, streamlined integration of various

processes in hospital like Outpatient Management, Inpatient Management,Operations,

Billing/Finance,Pharmacy,Lab,Radiology etc., in accordance with the workflows of hospital.

Lifetrenz HIS is a user friendly, and it can be and deployed in a short time. The key

differentiator between other solutions and dwise solution is it is a Patient Centric World

Class Solution, compliant to International/ Indian EHR & WHO Standards, such as ICD-10,

SNOMED-CT, LOINC, UMLS, Rx Norm, NANDA, NIC, NOC, DICOM, bringing down the cost of

delivery of healthcare without compromising on quality of car

1.5.Organizational Structure

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1.2 Importance of IT in Healthcare

Health IT (health information technology) is the area of IT involving the design, development, creation, use and maintenance of information systems for the healthcare industry. Automated and interoperable healthcare information systems are expected to improve medical care, lower costs, increase efficiency, reduce error and improve patient satisfaction, while also optimizing reimbursement for ambulatory and inpatient healthcare providers

Electronic Health Record (EHR) is one such technology that can transform delivery of healthcare by ensuring safer and better quality of care for patients.

EHR

Electronic Health Record (EHR) is defined as a systematic collection of electronic health

information aboutindividual patients or populations. It is a record in digital format that is

generated by one or more encounters over a period of time at differenthealthcare providers and

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therefore it’s often referred to as a longitudinalrecord- rather than information from a single

visit to a doctor or hospital. It is capableof being shared across different healthcare settings.

Such records include a wholerange of data in comprehensive or summary form,including

patient demographics,medical history, progress notes, problems,medications and

allergies,immunisationstatus, laboratory test results, radiology images & reports, vital signs,

personal statuslike age, height, weight etc. Its purpose can be understood as a complete record

ofpatient encounters that allows the automation and streamlining of the workflow inhealth care

settings and increases safety through evidence based decision support,quality management,

and outcomes reporting.

Benefits of EHR

It helps the physicians to provide quality care.EHRs provide financial, clinical and administrative/

operational benefits toproviders. Few of the ways EHRs can help improve care are:

Access by Multiple Health Providers: Because it can be accessed by logging onto a computer,

EHR "travels" from doctor's office to doctor's office. This can be helpful in an urgent setting. If

someone isunconscious and cannot tell an emergency room doctor about an allergy to certain

medications, the ERdoctor will know from looking at that person's EHR. EHRs also make it easier

for primary doctor tocoordinate with any specialists he or she might refer. Everything they need to

know about a person'shealth is right at their fingertips.

No more handwriting mishaps: The drawbacks to handwritten health records go beyond hard-to-

readhandwriting. When doctors and nurses take notes, they're more likely to abbreviate to save

time, andthere's always a risk they'll forget what they meant or that someone else looking at the

chart won'tunderstand the abbreviation and have to find out what it means. EHR software helps

clinicians be bothdetailed and fast by providing a series of prompts and dropdown menus to click

through.

Efficiency: When information is kept together in one central file, it helps doctors avoid ordering

testthat another doctor has already ordered. Eg: If a person consults a primary care physician

because of a knee hurt and if he or she orders an X-rayand then refers to an orthopaedic expert for

treatment, that expert can also see the same X-ray. Then, if physical therapy is needed, the therapist

can see it too — along with both doctor's notes and thespecialist's notes.

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Education: Being able to see one's own medical files helps the patients take part in own health

care.Apatient can view test results, keep track of things like blood glucose level, if the person is

diabetic or lungfunction for asthma patients, review the medical team's instructions, and even

check for errors.

Security: There's always the chance that paper records can get lost or misfiled or somehow

damaged.For example, paper medical records for thousands of patients were destroyed by

Hurricane Katrina in2005 in the US. There's less chance of this happening with electronic records.

Indian EHR Standards

EHR systems are built on published standards and this ensures that data is captured compliant

tostandards and makes them inter-operable or sharable among different healthcare organisations.

At

National level patient data becomes available to governments to do various kinds of analytics on

thepopulation health.The Ministry of Health, Govt of India, had set up a committee to finalise

standards for Electronic HealthRecords (EHR) in India and this committee submitted its final

recommendations to the Govt in April2013. These standards have been approved by MOH & FW,

Govt of India in August 2013 to be adoptedby Healthcare providers and hospitals providing

primary, secondary or tertiary care in India. Lifetrenzsolutions are the only solution available in the

country as on date that are fully compliant to thesestandards.

Components of EHR

The various components or major parts a good EHR must have are:

Administrative system components

Clinical Decision Support System (CDSS)

Computerized physician order entry(CPOE)

Clinical Documentation

Laboratory,Radiology, Pharmacy system components

Health information exchange

Chapter II

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Hospital Management Information System (HMIS) and

Implementation Process of dwise Healthcare

Section 1: HMIS Modules

The HMIS Software consists of following Modules

2.1. Outpatient

It covers all the process like Patient Registration, Appointment Management, Billing,

Physician consultation Prescription for Medications, Laboratory Investigations, Radiology

tests and other OP services and their billing and patient check outs.

Out Patient (OP) Registration

This is very user-friendly and quick, thus removing a major bottleneck in a hospital’s OP

operations resulting in immense saving of valuable time for the patients. .

OP Registration has 3 main features

i) Quick Registration

A patient can be registered quickly in Lifetrenz using a Minimum Data Set with just Name,

Age and Gender. This ensures reduced registration time and avoids long and annoying

Queues at the Registration Counter. This also helps when registering a patient over a

telephone call (telephonic request for an appointment) or from the patient portal. A quick

registration can be converted to a full registration at any point in time.

ii) Avoids Duplicate Registrations

While registering a patient, the system automatically checks for possible duplicate records

for the same patient and help avoid duplicate registrations. This also ensures that a lifetime

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EHR is uniquely maintained for each patient; although, in case of duplication of patient

records, there is a feature available in Lifetrenz to merge.

iii) Unique Lifetime Master Patient Index (MPI)

It provides a unique, Patient ID for lifetime for each patient registered in the system. This

helps identify a patient uniquely, not only at the registering hospital but also across

multiple hospitals & clinics within the same group, avoiding duplication of records and

enabling care givers and patient’s seamless access across all hospitals/ clinics within the

chain, making the system a true EHR as opposed to an EMR. This unique MPI can be linked

to the UID (Aadhar Card) making it compliant with Indian EHR standards approved by GOI.

OP Appointment

OP appointment is done by front desk executive. Besides, Physicians also can give

appointments for the chain of clinics he is working. This module consists of the following

sub-modules such as i) Physician' Appointment across the same chain and ii) Re-scheduling

of Physicians appointments and iii) Re-scheduling of Physicians appointments

i) Physician Level Appointment

It consists of different type of appointments such as token based, fixed time slot based or

variable time based, at individual physician level. This means based on individual

physician's preference and patient load, the hospital can choose a flexible type of

appointment type that best meets the business objectives.

ii) Physician' Appointment across the same chain

For physicians practicing across different hospitals & clinics in the same chain, this

application allows appointments to be created at any of the hospital or Clinic within the

group, where the physician has practicing rights. This combined with seamless access to

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patient EHR from any of the location, brings in a different paradigm in patient convenience

and care delivery.

iii) Re-scheduling of Physicians appointments

It has the provision for bulk re-scheduling of any Physicians' appointments.For example, in

case of non-availability of a physician for a specific time period, all the appointments

scheduled for that period of practice by the physician can be rescheduled to another date

or a different physician.

OP Billing

It captures all the charges for services delivered to the patient.it includes consultations

charges , lab , Radiology , minor procedures and physiotherapy etc. here op billing system

is designed to accurately bill for all the services, taking inputs from the charge masters

created in hospital management solutions.

OP Consultation

This Process covers all the steps in an Out-Patient encounter with the Physician in a

Hospital.The Out-Patient Consultation process takes over the patient, after patient

registration. The Patient from appointment to Check-out. This involves processes such as -

Patient Pre-consultation with a Nurse or a Doctor's Assistant (Junior Consultant) before the

actual consultation with the Doctor, Doctor's consultation (History, Examination, Diagnosis

& Orders/ Plan of Management), Electronic Prescriptions for Medications, Lab & Radiology

services and other orders and fulfilment of all the e-Prescribed orders. All the processes are

captured and the billing is done automatically. The OP consultation process culminates

either in the Patient Check-out or admission as an In-Patient.

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OP Check-out Process

At the end of an Out-Patient visit, if the patient is advised a follow up at a later date, an

appointment can be created for the next visit, either directly by the physician or the

appointment desk.

2.2 IP Admission

IP admission process,an integral part of the ADT_ admission, discharge&Transferprocess of

the hospital. This process can also take e-admissions directly from out- patient

consultation(or) Emergency Room(or)Day Care, which enhances the efficiency of hospitals

operations

Inpatient-Nursing

IP nursing module aims to ensure easy adoption and usability by nurses with high work

load. Studies have shown a good electronic clinical documentation systems can save as

much as 24% of a nurse’s time, which can be productively used for patient care.

IP Physician Process: Appointments for follow-up patients is done by the physician.

Surgery Management

Scheduling and managing surgeries are critical tasks in a Hospital. Operation theatres and

associated activates are the nerve centre of hospital and performing the task of

savinghundreds of lives.

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Patient Transfer

During the process of IP encounter,many occasions arises where in a patient is required to

be transferred from one patient care location to another. It is important to track the location

of the patient at any given time and facilitates through the patient transfer feature, which is

part of the Admission discharge and Transfer(ADT) module. It also records any change in

room /bed or level of care which is important from the billing perspective so that correctand

accurate charges are made in patient’s bill.

Patient Discharge

It is a key activity in an In- patient management at any hospital. It’s an important factor.

This contributes to the patient satisfaction and operational efficiency of the hospital.

2.3 Emergency Room (ER)/ Day Care

The emergency room Being a fast dynamic , transient and high turnover

clinicalenvironment which needs quick registration, Triage and tracking of patients, speedy

andeasy input of data and orders ,high usage of protocols ,provision to handle Medico

legalcases and continuum of care, if patient is admitted to IP.

2.4 Traiage

EfficientTriage system enhances the efficiency and quality of care being delivered in the ER

department. It has in-built triage systems to assess the condition of the patients and decide

the course of the emergency care that needs to be delivered.According to this ‘transfer’ of the

patient done can be done from one department to another department and also admission

can be done in IC

2.5 Follow up

Follow up appointment is done by the physician and Front desk executives. It is designed for

delivering quality care quickly and without errors. It provides reliable andhigh quality patient

care.

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2.6 Discharge

ER/Day care module has all process from admission, Triage followed by clinicalassessment,

follow-up & ultimately the patient discharge process. At the end of ER/Daycare visit, the

patient may check out and back home or may be admitted to IP or may betransferred to

another healthcare facility. Lifetrenz has complete workflows to handle thescenarios.

Section 2: Implementation Process of HMIS

Implementation of HMIS consists of the following process:

1. Collection of Information from the hospitals

2. Mapping the requirements with the products

3. Realize the gaps

4. Configure: implementation team configure the things

5. Developing the team

6. On-site implementation

1. Collection of information from hospital (requirement gathering)

Information on the needs and requirements for both clinical and non-clinical are

collected from the hospitals. Clinicalinformation consists of details related to doctors,

treatment, and access for the doctor, construction assessment form, etc. Non-clinical

information consists of billing, dashboard management, finance management, charge

master management etc.Example: Few hospitalsrequire software for revenue

management whereas few don’t want. Therefore, it is vital to understand their needs in

detail.

2. Mapping the requirements with the products

Needs and requirements gathered from the hospital is compared with the existing

default software of dwise.

3. Realize the gaps

If any gaps found, it is informed to the developing team to develop the requirements.

They build the specific features to the requirements. If it is unique they will charge.

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Requirement Gathering

Map the Requirements with the products

Realize the gaps

Developing Team

Onsite Implementation

Training (hand holding, elbow support)

4. Configure

Implementationteam configures the requirements in the software and thereafter starts

onsite implementation.During on-site implementation, training is provided to the staffs

for their respective fields of operation/work.

Approximately, it takes 1 week to on-site implementation of the software and training

the staffs. However, the time depends upon the bed size of the hospital.

Work flow

After implementation of the software, to support the hospital in-case of any problems,

support team from dwise is allocated to fix the tickets. Approximately, support is provided

to the hospitals for 2-5 days.

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Chapter III

Primary Care EHR Management

3.1 Primary Care EHR Management Software

Electronic Medical Records Software is a program that helps to convert and store the

medical record of a patient into a digital format. The information is usually places or stored

in a database that is accessible from anywhere via a secure network by authorized

personnel. Electronic Medical Records (EMR), or Electronic Health Records (EHR) contains

important data about the patient such as lab results, blood tests, inoculations, prescriptions

etc,. This app is mainly designed for doctors who are giving primary healthcare in clinics.

How to use the Practice Management of EHR for Doctors

First registration needs to be done with doctors’ portal. There is no fee for

registration

Then user name and pass word is send to Gmail account

Can open the link through using the id and password

It consists of 8 modules. They are:

1. Appointment

2. Nursing

3. Consultant

4. Medical records

5. Reports

6. Alerts

7. Live chats

8. Social Tools

Alerts, Live Chart, Social Tools are under development.

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3.1.1 Appointment

Time scheduling will be available according to the doctors’ available timings and dates.It

consists of ‘new appointment’ and ‘confirmed appointments’ and ‘billing’. It also has the

option to ‘reschedule’ the appointment, ‘cancellation’ of the appointment.

Different colour coding is used for indicating the ‘status of appointment’ such as Available

-Green, Scheduled - Red, Elapsed – Purple, and Holiday - Ash Colour.

Image 3.1.1 Appointment

3.1.2 Nursing

In this module appointments list will appear, the nurse had to select the patient who needs

to be assessed and then click the tab ‘continue’ and start assessing the patient. Assessment

format includesa) subjective, b) objective, c) Diagnosis/assessment andd) plan

order(SOAP) to assess the patients. Home Screen of the app contains patient name, reason

for visit, appointment time, phone no, age etc.

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Image 3.1.2 Nursing module

a) Subjective (history) analysis consists of the following tabs

Patient complaint

History of present illness

Past diagnosis

Past procedure

Patient allergy

Family history

History - Birth, Nutritional, Hearing and Phototherapy

Life style history (diet, tobacco,sleep pattern, physical and occupation,Alcohol and

travel)

b) Objective Assessment (Examination)

In objective assessment clinical findings of the patient and patient clinical alert are not

active in nursing module. The objective assessment consists of the following tabs:

Vitals Growth chart

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General examination

c) Diagnosis: Diagnosis/Assessment is not active in the nursing module

d) Orders (PLAN)

It consists of home / active medication, medication, Lab, Radiology, Procedures, Other

orders (patient advice, diet advice, speech order, Immunization, Occupational therapy,

speech orders).

3.1.3 Consultation

In this module appointments list will appear, the nurse had to select the patient who needs

to be assessed and then click the tab ‘continue’ and start assessing the patient. Assessment

format includesa) subjective, b) objective, c) Diagnosis/assessment andd) plan

order(SOAP) to assess the patients. Home Screen of the app contains patient name, reason

for visit, appointment time, phone no, age etc.Image 3.1.3 Consultant Module

a) Subjective (history) analysis consists of the following tabs

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Patient complaint

History of present illness

Past diagnosis

Past procedure

Patient allergy

Family history

History - Birth, Nutritional, Hearing and Phototherapy

Life style history (diet, tobacco,sleep pattern, physical and occupation,Alcohol and

travel)Image 3.1.3 consultant Module

b) Objective Assessment (Examination)

In objective assessment clinical findings of the patient and patient clinical alert are not

active in nursing module. The objective assessment consists of the following tabs:

Vitals

Growth chart

General examination

Clinical Findings

Patient clinical Alert

c) DiagnosisAssessment

It consists of ‘Current Diagnosis’ and ‘Active diagnoses’.

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d) Orders (PLAN)

It consists of home / active medication, Medication, Lab, Radiology, Procedures,Other

orders (patient advice, diet advice, speech order, occupational therapy, Immunization,

Occupational therapy, speech orders).

3.1.4 Medical Records

It consists of all patient related information like Name of the Patient, Master Personnel

Index (MPI),Gender, Phone No, Age, and ViewRecord Option. With the help of ‘View

Record’ the physician can access the complete record of the patient. Image 3.1.4 Medical Records

3.1.5 Reports

Reports consists of a) Dashboard (How many new visits, how many old patients), b) Slot

utilization,c) Demographics Report, d) Billing Report.

a) Dash Board

In Dash board the physician or management can view the number of new and old patients.

Image 3.1.5 a) Dash Board

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b) Slot Utilization

This screen contains date, regular slot timings, waiting lists,elapsed slots, and completed

slots.Image 3.15 b) Slot Utilization

C) Demographics Report

In these complete details of the patient such asName of the Patient, Age, Gender, MPI No,

Aadhar No , Phone No, Email No.etc. is available.

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Image 3.1.5 c) Demographic Report

d)Billing Report

In billing report, the following information will appear viz., bill no/item no, total

billamount, any concessions, payment mode. Image 3.1.5 d)Billing Report

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Chapter IV

Acceptability, Reasons for Adoption & Non-Adoption of Primary care

EHR among Doctors

4.1 Objectives of the Study

To understand the acceptability of Primary care EHR by doctors in clinics

To identify the reasons for adoption and non-adoption of Primary care EHR by

doctors in clinics

4.2 Methodology

Study Area:Bangalore

Tools of Data collection

Interviewed schedule was developed and was incorporated in the mobile app was used to

collect the data from the respondents.

Sampling

Convenient sampling was adopted to collect the data since; the list of clinics was not

available.

Sample Size

Total number of doctors’ interviewed was100

4.3 Findings of the Study

4.3.1 Acceptability of Primary care EHR by doctors in clinics

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A large number of (80%) of the doctors are willing to use the primary care EHR andare

already using software. During the interview the doctors were saying that they like to use

the software since itreduces thetreatmenttime, errors, increase the quality of the treatment

and can maintain the patients’ record for long time and all the information about particular

patients can be kept from the time of birth.

4.3.2 Reasons for adoption of EHR Software by doctor

Can save time, space and money

It is effective in reducing the possibility of human errors such as misspellings,

illegible handwriting and differing terminologies. This helps to standardizethe

patients’ health records.

It eliminates the possibility of losing important information about the patient.

Digital storage of important data can be kept forever without the risk of losing it and

preserve previous information that could be useful in the future treatment of the

patient.

EHR Soft wear can help make health care cost-efficient by consolidating all the data

in one place. Paper records are generally located in different places and older

records may be stored in a locked room or even away from the office. EMR offers a

systematic approach. It allows you to easily access of the necessary data with a

computer. This also allows easier referral to specialists since complete medical

history of the patient is available.

Increases patient profitability and serve up to 80 % on labs and up to 40% on

medical and office supplies, phone services and more.

It empowers the patient to take control over their health and improve outcomes

with an advanced patient portal that allows patients to engage with and become an

active part of their health care.

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Operation can be streamlined with a cloud based virtual officeassistant that shaves

hours of administrative tasks off each day.

After Government of India guidelines, primary EHR is used by the primary doctors working in small clinics as well as small hospitals.

S. No No. of. Doctors visited Acceptance of doctors / already using HER

Not -interested

1 100 80 20

Reasons for non-adoption of EHR Software by doctor

Senior doctors who are more than 60 years of age they rejected (1out of 2) because

they said they are happy and comfort with traditional way of writing on paper.

Consumes time since need to type the information clicking on respective tabs

Doctor- patient Interactionwill be hampered/less attention to complaints shared by

the patient

Maintaintence of the internet speed is not possible

Infrastructure

For the better EHR implementation healthcare infrastructure plays an important

role . During visit many clinics are not having proper infrastructure such as

computer.

There is no internet connectivity in clinic as internet connection required for

software implementation.

The clinics don’t have proper setup of their clinic

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Recommendations

Usage of EHR Software can be increase by providing low internet speed and less set

up by software companies.

If that EHR software is more User-friendly then usage will be more.

EHR Software usage can be increase by initiative taken by Government of India like

tax reduction for EHR software using hospitals.

32