Investigating Electro Medical Record (Smart Care Software) Implementation In A Health Care Facility: A Guiding Framework For Adama Hospital Medical College

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Addis Ababa University


Background: In Ethiopia, electro medical record (smart care software) was introduced in 2007/2008 in collaboration with the smart care teams’ of Zambia and United States as part of HMIS reform. The smart care software has become a necessary tool in health care for improving patient quality care and enhancing quality health management information system. However due to several factors; lack of optimal knowledge on computer usage by health professionals and their commitment there are gaps to implementing electro medical record (EMR). Objective: The aim of this project is to investigate electro medical record (smart care software) implementation in a health care facility a guiding framework for Adama Hospital medical college. Methodology: Cross sectional study design with qualitative and quantitative approaches was conducted on 177 EMR users at Adama hospital from January 01, 2015- April 30, 2015. In this study, personal observation on documents related to EMR, interview and questionnaires were used as data collection tools. The data were collected by investigator. Quantitative data were coded and analyzed using SPSS statistically software version 16. The opinion of respondent were recorded, summarized, analyzed and presented in a readable product in comparison form related study conducted in different area. Multiple regressions were used to identify factors contributing to electro medical record (EMR) implementation. Electro medical record (EMR) implementation success and failure were measured based on twelve nationally stated benefits: legibility of record, safer data, patient data confidentiality, continuous data processing, always up to date, simultaneous remote access to patient data, integration with other information resources, incorporation of electronic data, greater range of data output modalities, flexible data layout, assisted search, and tailored paper output. Meanwhile a guiding framework was designed and evaluated based on experts’ opinion. . Addis Ababa University Health Informatics Program xi | P a g e Result: According to the investigation made on EMR implementation success or failure based the twelve nationally stated benefits. Parameters as success were; legibility of record (91.5%), safer data (77.4%), patient data confidentiality (78.5%), continuous data processing (57.6%) and always up to date (53.1%). However the following seven parameters that should have been expected as benefits were found as failures. These include simultaneous remote access to patient data (100%), integration with other information resources (100%), incorporation of electronic data (100%), greater range of data output modalities (100%), flexible data layout (41.8%), assisted search (24.9%) and tailored paper output (24.3%) In this study, attitudes of users towards EMR usage (α= .001), variation in number of training days among users (α = .001) , exchange of electronic information via networking between departments (α = .010), experience variation on using the smart care software among users (α = .001), disparity of the expectation drown by users during the training period and its contradiction on actual working environment (α = .005),were found statistically significant causes for failures EMR usage at Adama hospital. Discussion and Recommendation: The system was initially implemented in twenty seven service areas. However gradually the implementation was limited only to six departments and currently was functional only in two departments. In this study the overall EMR usage success and failure rates was 41.7 % and 58.3 respectively. This indicates that more remained to be done on EMR implementation success at Adama Hospital. Based on major study findings made a guiding framework is proposed. In this framework inputs introduced from the study findings are system quality, user involvement, human resources, integration, capacity building, perceived usefulness, incentive, perceived easy for use, technical support, monitoring and evaluation, user promotion, interoperability, innovative leadership, and website. Overall this guiding framework is expected to bridge the existing gap in EMR implementation at Adama hospital.



EMR, Smart care Software, Success, Failure and a guiding framework