Issues and Challenges in EHR

ImplementationRoy Dahildahil, RMT

Electronic Health Record

• The electronic health record includes all information contained in a traditional health record including a patient’s health profile, behavioural and environmental information. As well as content the EHR also includes the dimension of time, which allows for the inclusion of information across multiple episodes and providers, which will ultimately evolve into a lifetime record (Mon, 2004, Amatayakul, 2004).

Security Confidential

ityReliability

TechnologyAccess

Interoperability

CostLanguageCulture

• Security measures to prevent breach of information• Privacy, confidentiality and quality of

information generated • Quality of electronic healthcare

information and accuracy of data entries • Accuracy and validity of the original source

data• Reliability – data is consistent and

information generated is understandable; • Completeness – all required data is present;• Legibility – data is readable;• Currency and timeliness – data is recorded

at the point of care; and• Accessibility – data is available to authorized

persons when and where needed. (WHO)

Security, Confidentiality

Reliability

Technology• Availability of technological infrastructure to

implement EHRAccessibility• Concern by providers as to whether the

information they generate will be available on request

• Philippines: Poor internet connectionInteroperability• Clinical Data Entry – Standard Dictionary• Diagnosis that are not in ICD 10• Local terms

TechnologyAccess

Interoperability

Cost• High Cost of Computers and Computer Systems and

Funding Issues• Implementation and maintenance of the system• Manpower issues – lack of staff with adequate skills

Culture• Strong Resistance to Change by Many Healthcare

Providers• Resistance to Computer Technology and Lack of

Computer Literacy• Involvement of clinicians and hospital administrators

Language• Lack of staff with adequate knowledge of disease

classification systems• Environmental issues

CostLanguag

eCulture

Safeguards• Data back-up as in any computer system, there must be an efficient back-up

system available • Contingency plans for disaster recovery also need to be in place in the case of

an electrical breakdown or other emergency• Access control to ensure health records are available when needed for patient

care and other official purposes but may not be accessed by unauthorized persons • Audit controls where access may be monitored to ensure only authorized

persons use the system and to identify when changes are made in the record