EHR Issues and

ChallengesHI 201

James Carlo N. Garcia, RN

Driving Question: Aside from cost, what are the issues and challenges in implementing an electronic health record in (the setting of your choice) and how would I approach/resolve them?

I provided my own approach in solving the issues that I have identified followed by a line from an article, case study or a blog as evidence that my proposed solutions could be done and applied here.

Answer: The following are the issues and challenges that I believe hinders the effective implementation of EHR in Public Health especially in Rural Health Units and Barangay Health Stations located at Geographically Isolated and Disadvantaged Areas (GIDA):

- Availability of Continuous Power Supply- Staff are Reluctant to use an EHR- Availability of Reliable Internet Connections

Availability of Continuous Power Supply

One major problem of implementing EHR in rural health units especially those located at Geographically Isolated and Disadvantaged Areas (GIDA) is the availability of continuous power supply for computers to run.

My Approach: I would suggest using solar panels. I’ve seen some RHUs using solar powered refrigerator for vaccine storage, so why not use solar panels to provide electrical power to the RHU itself.

“Because local electric power is unreliable, there are multiple redundant back-up systems. In order of use, the MMRS runs on the local power grid, a 45-minute UPS battery, and a 4-hour solar-powered battery.”‘Crossing the ‘digital divide’: implementing an electronic medical record system in a rural Kenyan health center to support clinical and research.’ by Tierney WM, Rotich JK, Smith FE, Nii J, Einterz R Mand Hannan TJ. Proceedingsof the AMIA Annual Symposium 2002;792–5

Staff are reluctant to use an EHRI haven’t seen this personally in RHU’s that I have visited because they are not yet using any form of EHR, however I believe that this would be an issue once EHR is introduced to their facility because most of the staff in those RHU’s are older. Many literatures already suggests that older health workers tend to be afraid or reluctant to use any form of technology because they believe that they won’t be able to learn and understand it due to their age.

My Approach: During training in the use of EHR, I would make sure that the training is as light as possible. Also, I would address their anxiety by providing examples or by relating those examples to things that they are already doing or are already familiar to them. (I know that this is easier said than done, but it’s worth a try.)

“Older physicians are less likely to use an electronic health record system than their younger counterparts. A recent Health Affairsstudy found that in 2011 30.8% of physicians older than age 55 were using a basic EHR system, compared with 40% of doctors younger than age 40 and 35.5% of doctors ages 40 to 55.”'Age Is Just a Number' -- Does It Hold True for EHR Adoption?by Kate Ackerman, iHealthBeat Managing EditorMonday, July 23, 2012

http://www.ihealthbeat.org/insight/2012/age-is-just-a-number-does-it-hold-true-for-ehr-adoption Accessed on Sept. 28, 2014 5:00 PM

Availability of Reliable Internet Connection

Most RHU’s don’t have access to a reliable internet connection especially those located at GIDA areas and those in lower class municipalities. Also, the Philippines is among the countries in the Southeast Asian region with a very slow internet access. Although some EHR are designed to run even without the need to connect to the internet, most EHR are internet reliant.

My Approach: I would suggest using satellite internet connections.

“To assure continuity of services regardless of remoteness and environmental conditions, CS2 proposed to use a combination of satellite and terrestrial Internet services to provide parallel and redundant communications paths.”‘AMSANT Case Study: AMSANT Secures e-Health records in remote Australia with DIGIPASS’ by VASCO https://www.vasco.com/images/amsant_web.pdf Accessed on Sept. 28, 2014 5PM

“With internet via a satellite you can get 99.6% up-time, and the associated cost are low. “99.6% up-time” means that the connection is rarely “down,” even in severe weather. Additionally, the end-user Satellite infrastructure is easy to install and maintain; locals can be trained online in a short period of time; and the satellite system only uses 15 watts of power so this too can be inexpensively solved with a low cost solar panel and a 12 volt car battery for storage.”

‘Connectivity: A Problem & A Solution’. E-Health Records Internationalhttp://ehrinternational.com/2014/07/17/connectivity-problem-solution/ Accessed on Sept. 28, 2014 5PM