• USA physicians' relationships with EHRs deteriorates

    A scroll through eHNa’s search shows several articles on USA physicians’ dissatisfaction with their EHRs. They provide salutary eHealth lessons for Africa’s health systems. There’s new information from 940 USA physicians.

    A report from AmericanEHR and the American Medical Association (AMA) shows it’s deteriorated by about 50% over the last five years.  Physician Use of EHR Systems 2014 found that about half reported a negative impact to questions about how their EHR improved costs, efficiency or productivity.

    A study in 2013, by RAND, sponsored by the AMA, identified several issues with physicians EHRs. Its recommendations were:

    “Physician practices need a knowledge base and resources for internal improvement. As physician practices affiliate with large hospitals and health systems, paying attention to professional satisfaction may improve patient care and health system sustainability. When implementing new and different payment methodologies, the predictability and perceived fairness of physician incomes will affect professional satisfaction. Better EHR usability should be an industrywide priority and a precondition for EHR certification. Reducing the cumulative burden of rules and regulations may improve professional satisfaction and enhance physicians' ability to focus on patient care.”

    It seems that some of these issues may not yet be resolved. A press release by the American College of Physicians summarises the findings from five years ago and compares them to the current findings as:

    It’s about a 45% drop in satisfaction. The current findings are:

    42% thought their EHR’s ability to improve efficiency was difficult or very difficult 72 thought EHR’s ability to decrease workload was difficult or very difficult 54% said their EHR’s increased their total operating costs 43% said they hadn’t yet overcome their EHR’s productivity challenges.

    As Africa’s health systems expand their use of eHealth, it’s important that they make sure that the new information systems live up to their expectations. Part of the process is engaging health workers throughout assessment, selection, procurement, implementation, training, operation, impact, cost and benefits. The USA offers valuable experiences and lessons on all these. 

  • Medscheme's new EMR coming soon

    Medscheme, a subsidiary of the AfroCentric Health Group and South Africa’s largest health risk management services provider, has announced it’s rolling out an Electornic Medical Record (EMR) platform. The ultimate goal of an EMR is to optimise the quality of care of patients by providing healthcare professional with more complete patient information that improves their ability to make well-informed decisions. Medscheme believes its new EMR will do just that.

    An article in African Healthcare IT News reports Medscheme CEO, Kevin Aron saying that many EMRs have missed the mark and have not delivered the healthcare benefits they claim. Many healthcare providers have been frustrated by the lengthy processes to capture information and having to use numerous platforms from different administrators, each with its own access specifications. This has resulted in wasted time, decreasing the quality of care as health workers spend more time capturing data, taking their time away from treating patients and decreasing efficiency.

    Medscheme’s EMR has been developed with the aim of removing these obstacles. Its EMR has been designed to streamline and improve workflow, not hamper it. More efficient workflow processes and integrated clinical information cuts down on administration time and enables healthcare providers to make better informed decisions due to accurate and up-to-date information at their disposal.

    Medscheme’s EMR is a customised version of the HEALTHone Connect platform, which is available to administrators. The EMR interfaces with Medscheme directly or through practice management software and is pre-populated with patient demographics, medical histories, pathology results, approved chronic medications, care plans and risk stratifications. It also comes with a function for GPs to monitor compliance with clinical pathways, modify treatment plans and use e-scripting.

    Medscheme’s EMR is currently available to 75 healthcare professionals and service providers through a pilot project launched in April this year. An extensive rollout’s planned when the pilot ends in September. Aron says the feedback during the pilot phase has been overwhelmingly positive, and they’re looking forward to seeing how the technology becomes a game-changer for the healthcare sector. Alongside this information, potential users need to know the costs.

  • EHR's aren't too good in the USA

    As African countries move steadily on with their EHRs, it may seem laboriously slow. It’s better than too fast. The American Medical Association’s encouraging physicians to share their EHR experiences, especially on usability and seamless information. Fierce EMR’s been following events.

    A post about the meeting in Georgia says:

    Physicians are facing numerous EHR challenges  EHRs have so much potential but it’s not the reality They’re blunting efficiency, diminishing effectiveness and interposing between physicians and patients Workflows are disrupted Productivity Projects are pushing on despite EHR problems They’re removing science from medicine There are interoperability problems Costs are too high The technology brings graduate degree-educated people to their knees.

    It doesn’t say if the genuflecting response is due to an excessive burden or resorting to the power of prayer. It could be both.

    Some physicians have stopped using their EHRs. Alongside these negative EHR view is a positive response for ePrescribing. It indicates that the EHR frustrations are not anti-eHealth, but a considerable, collective disappointment.

    The lessons for Africa’s eHealth initiatives are clear:  don’t go too fast and take the users with you. Anything less is fraught with risk.

  • My Healthspace is expanding in South Africa

    GPs and other health professionals use their eHealth in ways that suit their way of working. This flexibility is often very important for realising net benefits. Compared to imposing changes to clinical and working practices, enabling health professionals to choose is a better option.

    My Healthspace is a secure EHR developed by GPs in South Africa. Drs Pierre and Mia Hugo are behind the initiative that connects patients and health professionals with each other. It’s used by GPs, physiotherapists and other health professionals, as well as by patients. It enables GPs to:

    Provide a better healthcare experience for patients and health professionals Store medical histories securely online Share medical histories with other authorised health professionals View other health professionals’ notes Write and view scripts Store and view lab results Reduce the number of duplicate tests Save administrative costs by replacing paper systems Comply with health record regulations.

    Patients specify which health professionals can access their medical information, an important principle in eHealth regulation.

    Healthspace has also created a community of users that can provide an easy way to inform decisions on its future development. Direct engagement with health professionals and patients is an essential ingredient of eHealth success.

  • Meditech wins Frost & Sullivan 2015 Award

    Last week Frost & Sullivan awarded MEDITECH their 2015 Sub-Saharan Africa (SSA) award for Product Leadership. It’s based on recent analysis of the healthcare informatics product market and emphasises that the interoperability (IOp) of MEDITECH’s EHR platform offers significant value. Frost & Sullivan presents this award annually to a company that has an innovative product and gaining rapid acceptance in the market. It’s an important acknowledgement of MEDITECH’s SSA presence.

    MEDITECH’s African story emphasises the time and persistence required to succeed in this market. It started in South Africa in 1983, and it’s now in numerous countries including Botswana, Kenya, Mozambique, Namibia, Nigeria and Zambia.

    Over the last three decades it’s shown an ability to tailor its products to address SSA’s infrastructure and resource challenges and variability. Continuous investment in products has help it to address key SSA healthcare issues, such as connecting diverse facilities, from small clinics to large hosptals, and combating non-communicable diseases, enabling medical practitioners to deliver higher quality service to patients and facilitated improved communication between healthcare entities.

    “MEDITECH’s flagship solution consists of a high quality EHR platform with more than 40 administrative, clinical and managerial operating modules; a wider range of modules when compared to most of its competitors. This enables superior service in terms of tracking and monitoring of patients across the entire healthcare spectrum,” said Stephanie Craig, Frost & Sullivan Research Associate. “For example, the company developed HIV/AIDS and tuberculosis workflows, especially for clinics and treatment centres in South Africa, and ensures all its systems comply with country-specific financial requirements.”

    MEDITECH recognises the critical importance of dealing with IOp between data, people, and devices, across healthcare tiers and within organisations. Benefits are far reaching, including helping health workers to manage their workloads and use data already available to screen patients in primary healthcare and only refer to hospitals patients who need additional investigation or care. To support better IOp MEDITECH’s working to move to an open standard web-based interface that supports mobile technologies, and a more open database solution. These are not trivial endeavours, and show the company’s acknowledgement of their importance in SSA.

    “MEDITECH has also adapted its products to accommodate the limited infrastructure in SSA, particularly in terms of the low levels of Internet connectivity,” notes Craig. “In Botswana, where MEDITECH services medical outposts in very rural and remote areas, it works with the Ministry of Health to develop simplified versions of its electronic healthcare platform. These products can operate offline, and sync to the main database in Gaborone every few days. MEDITECH has achieved significant success in Botswana – the first country in Africa to have its entire public healthcare service sector running on one, integrated patient record.”

    Congratulations to MEDITECH. It’s moving Africa’s eHealth on.

  • EHRs need critical actions now

    American Medical Informatics Association (AMIA) EHR 2020 Task Force says near-term strategies to address current challenges in EHRs are needed. African healthcare has a similar focus, with the benefits of healthcare transformation and strengthening as a later phase. It identifies five activities and eight recommendations to succeed over the next five years up to 2020. They fit Africa’s requirements too:

    Simplify and speed documentation Refocus regulation Increase transparency and streamline certification Foster innovation Support person-centred care delivery.

    These result in a series of recommendations, some of which are generic good practices. They include:

    Decrease data entry burden for clinicians Keep data entry separate from reporting Enable systematic learning and research at points of care during routine practice Regulation should focus on:  Clarifying and simplifying certification procedures and regulations Improving data exchange and interoperability Reducing the need for re-entering data Prioritizing patient outcomes over new functional measures Changes in reimbursement regulations should support novel changes and EHR innovation Keep vendor certification criteria flexible and transparent to improve usability and safety, and foster innovation that empowers providers and EHR purchasers Healthcare organisations, providers and vendors should be transparent about unintended consequences and new safety risks of health ICT and adopt best practices for mitigating the risks EHR vendors should use public standards-based application programming interfaces (API) and data standards that enable EHRs to become more open to innovators, researchers and patients.

    The Task Force offers salutary advice on EHR programmes. “The problems we face today in EHR use are complex and solutions will not be simple or quick. Solving these problems will require regulatory stability, the development of an acceptable threshold “barrier to entry” into the EHR marketplace, and a supportive national policy.”  It sees the five areas as short term actions needed before developing long-term frameworks for EHR innovation.

    They’re good practices for Africa’s healthcare to adopt with the reality that EHRs need long timescales. Another view is that the timescales are a continuous succession of steps and changes that always have another set over the horizon.

  • Kenya's EHR pilot is underway

    The Kenyan Ministry of Health (MOH) is piloting an Electronic Health Records (EHR) system in Machakos County. The new system is designed to help health workers by streamlining access to patient records.

    An article in ITWEB Africa says the pilot was announced at a press conference to discuss the launch of the eHealth Conference taking place in Kenya from June 22 - 26 2015. The conference is expected to bring together 500 ICT professionals and health organisations to discuss how to improve the eHealth landscape in Africa.

    "We will be able to be in a scenario where we will have electronic health records for all Kenyans," Delano Kiilu Longwe, director at Oracle, healthcare and social services-public sector for Sub-Saharan Africa, said at the media briefing.

    Currently, there is no platform available through which all hospitals and doctors can access patients’ medical information. The proposed platform will be encrypted and patient information will be anonymous and secure.

    Longwe also said that the MOH is at an advanced stage of preparations for have a portal that will house all Kenya’s eHealth programmes and apps to ensure interoperability between different platforms. Everyone involved in any eHealth activities in the country will have an opportunity to register their eHealth project on the portal.

  • EHRs: lessons learned 7

    As Africa’s healthcare moves its eHealth initiatives on, EHRs will become an increasingly significant part of the investment portfolio. It’s vital that planning relies on the probability of costs and benefits, not their potential.

    Starting with potential, eHNA reviewed two studies, each investigating one of EHR’s important potential impacts, better outcomes for patients and better resource utilisation.

    The Journal of the America college of Cardiology (JACC) reported the results of a research project into strokes that found only one was achieved, and then only “slightly.”

    Patients in hospitals with EHRs had similar chances of receiving all-or-none care, discharge home and mortality in hospital than patients admitted to other hospitals. The chances of having a length of stay shorter than four days, was slightly lower at hospitals with EHRs. The simple conclusion was that the sample shows that EHRs were not linked to better quality of care or clinical outcomes.

    This doesn’t mean that EHRs aren’t worth it. It does indicate that claims for better quality healthcare by using EHRs need to be assessed critically. There are often other benefits, so it’s important that Africa’s healthcare is clear and realistic on the probable benefits of EHRs for their settings. The studies show the considerable difference between potential and probability. It’s probability that should guide EHR investment.

    eHNA has posted examples of EHR’s benefits for Africa, such as vaccination. It’s also posted on some of their downsides, like risks. In Are EHRs offering fewer health and healthcare outcomes? eHNA posted about a report in Healthcare IT News of a survey by Accenture of physicians in the USA. It says they’re more proficient at using EHRs, and use them more than in 2012, but fewer believe that EHRs lead to better patient care. Current performance is:

    79% are more proficient at using EHRs 30% routinely uses health ICT tools to communicate with their patients, up from 13% in 2012 82% of physicians input patient notes electronically 72% use ePrescribing 65% receive clinical results directly into patients' EHRs 63% use electronic administration tools 62% order laboratory requests electronically.

    For better quality, the findings don’t look so rosy. They include:

    82% allowing patients to update their EHRs, which leads to increased patient engagement, so promising, but 46% think that EHRs improve treatment decisions, down from 62% in 2012 64% said EHRs decreased medical errors, down from 72% of 2012 46% believed EHRs improve patient outcomes, down from 58% in 2012.

    Some of the challenges are seen as limited interoperability, improving poor usability and taking time away from patients.

    These features indicate that Africa’s healthcare could pursue EHRs, but should not expect major health and healthcare benefits too soon. This has two implications. One is that EHRs need healthcare transformation too. A balanced, affordable eHealth investment plan is a good approach for Africa.

    EHRs must support clinical work and research found that the value of patients’ registries aren’t exploited fully. They can provide data to track patients through their treatments to assess effectiveness and support research goals that can often lead to better population health management and clinical protocols and standards. To realise these benefits, registries need expanding across a wider range of conditions, such as cancers, cardiovascular disease and diabetes, and need more effective IOp with EHRs and better electronic data transfer. A report in Health Data Management says that the Pew Charitable Trusts wants registries to be able to extract information from EHRs and avoid the approach where registries are built and operated in isolation from other information systems.

    This integrated role needs wider and integrated eHealth strategies. African countries now have investment choices. Should they:

    Invest in EHRs, then deal with the registries and research and their IOp needs later? Integrate them, and spread their eHealth development resources more thinly? Integrate investment in EHRs and a few top priority registries and their IOp needs?

    These are challenging decisions when eHealth resources are limited. What’s clear is that registries and research can increase EHRs’ value.

    A claim for EHRs, and eHealth in general, is that they save time. EHRs may need extra staff found that they may save some staff time, but they also need extra staff. A report in Market Place Health Care says “The medical scribe industry has been booming in recent years, fueled largely by hospitals around the county switching to electronic medical record systems.”

    It says that EHRs are much more comprehensive than the paper files or computer spreadsheets the hospital used to use. They also take much longer, needing about ten minutes per patient. For 30 patients a day, it’s “an extra five hours charting.” This makes the benefits of EHRs harder to assess.

    Scribe America, one of the biggest USA medical scribe companies, says it’s tripled its growth in a year to almost 7,500 employees in 47 states. iHealth Beat says the American College of Medical Scribe Specialists estimates that the number of medical scribes in the US will increase from about 20,000 today to about 100,000 by 2020. Their job includes entering patient data using medical terminology and billing codes and recording physicians’ notes during consultations.

    As Africa’s eHealth moves on, it’s important it knows how to build these realities in. It needs to start long before it procures EHRs.

  • Australia's EHR shows eHealth's challenges

    Australia’s government plans to change its EHR project to gain more users. It reveals important challenges that Africa’s healthcare can learn from. A report in Australia’s iTnews summarises the changes.

    Its cumbersome name was the Personally Controlled Electronic Health Record (PCEHR). It was changed to the more alluring myHealth Record. Fewer than 10% of eligible Australians signed up for it on an opt-in model. The low take-up is undermining its clinical value, so change’s needed.

    A project review in 2013 says

    Implement a standardised secure messaging platform Priority supports for platforms that comply with standards Expand the secure messaging strategy to include secure communication exchange between healthcare and citizens Improve its usability Disband the National eHealth Transition Authority (NeHTA), the agency leading myHealth Record.

    It seems that NeHTA failed to act after it had consulted with the clinical community. Converting users’ and stakeholders’ ideas into practice, if they’re practical, is an important principle.

    A subsequent blog in the same outlet by Steve Wilson is the principal analyst at Constellation Research, says that security and privacy safeguards aren’t good enough. An example is that prescription details have been uploaded from community pharmacy to other patients’ records. He also doesn’t like the idea of changing consent models to improve take-up when the system needs improving. myHealth Record’s security must be improved and built in, not retrofitted.

    He says there are two sources of improvements. One is the Threat and Risk Assessments (TRA). The other’s the Privacy Impact Assessments (PIA). They show that the required security and privacy controls need a mix of technology, policy and process. This relies on the principle of privacy by design.

    As Africa’s eHealth expands, it needs to learn the lessons from Australia. eHealth can be beneficial but on a large scale, it’s not always easy. Lev Grossman, author of The Magicians summed it up. He said “It wasn't that things were harder than you thought they were going to be, it was that they were hard in ways that you didn't expect.”

  • EHRs may need extra staff

    A claim for EHRs, and eHealth in general, is that they save time. They may save some staff time, but they also need extra staff. A report in Market Place Health Care says “The medical scribe industry has been booming in recent years, fueled largely by hospitals around the county switching to electronic medical record systems.”

    It refers to Cheyenne Regional ER Doctor Amy Tortorich saying that EHRs are much more comprehensive than the paper files or computer spreadsheets the hospital used to use. They also take much longer, needing about 10 minutes per patient. She usually sees about 30 patients a day. “That’s an extra five hours charting. So half my shift, almost half my shift.”

    This is only part of the story. She also says she sees more patients, who usually leave happier, making medical scribes well worth their cost. From an African perspective, the increased EHR workforce results in affordability challenges that lead to productivity gains. This makes the benefits of EHRs harder to assess.

    An indication of the affordability challenge is from Scribe America, one of the biggest USA medical scribe companies. It’s tripled its growth in a year to almost 7,500 employees in 47 states. iHealth Beat says the American College of Medical Scribe Specialists estimates that the number of medical scribes in the U.S. will increase from about 20,000 today to about 100,000 by 2020. Their job includes entering patient data using medical terminology and billing codes and recording physicians’ notes during consultations.

    As Africa’s eHealth moves on, it’s important it knows how these features need building in. An optimal relationship between affordability and productivity’s not easy to find.