Abstract
Using Electronic Medical Records (EMRs) have been proven to be an ideal method in accessing and storing data and securing patient information as compared to the use of printed or written medical records of methodologies. The ease in accessing data and an improved precision in retrieving medical data can greatly improve the quality of patient care that would be administered to patients who have acute medical cases, hence saving lives.
On the other hand, financial aspect tends to affect the implementation of EMR during its initial phase of implementation. Consequently, this leads to longer implementation time in cases where the amount of capital is less in terms of implementing EMR.
This paper aims to develop a comprehensive research on electronic medical records in order to serve as a bridge between science and healthcare. It will explore the influence of practice and individual physicians on the use of EMR. Particularly, the research will show how EMRs allow one to study large samples of medical records and clinical datasets, which can help enormously in understanding disease etiology and outcomes in various disease populations, as well as in assisting treatment methods.
Keywords: EMR (Electronic Medical Records), patients, physicians, service delivery, patient care, documentation, software technology, phase.
Methodology
This paper is a research on electronic medical records in order to serve as a bridge between science and healthcare. It will explore the influence of practice and individual physicians on the use of EMR. Particularly, the research will show how EMRs allow one to study large samples of medical records and clinical datasets, which can help enormously in understanding disease etiology and outcomes in various disease populations, as well as in assisting treatment methods. The research will, therefore, try to evaluate the following:
1. How are EMRs used in clinical practice?
2. How the use of electronic medical records nationwide has improved quality and convenience of patient care?
The research will employ the use of EMR system and use assessment survey, as well as a site visit, which is included in 1-hour interviews and observations with head nurses, office staff, and physicians. This will be done to see how each one was able to work with their EMR.
Conceptual Framework
This part of the research study included a use assessment survey, an EMR system, observation guide, case study template, an interview guide, and transcription codes. The EMR system and use assessment survey consisted of seven pages and had thirty questions that dealt with user satisfaction. The questions were divided as follows; there were nine open ended questions that were asking about system usage, twelve questions were concerned with information quality, eight questions dealt with system quality, six questions were concerned with the health specific and there were also seven questions on information quality. Lastly, there were a total of three questions that dealt with demographic information.
The interview guide used in the research study was drafted in such a way that it prompted responses from the respondents on various study areas. These areas include the EMR cost and its benefits, patient feedback after use of the EMR, the impact of EMR on patient care, the impact of the use of the EMR to the organization and other benefits. In order to protect the respondents’ privacy, the interview template also included a consent form that was used to get permission from the respondents to allow audio recording during the interview. The interviews were recorded in two languages, namely French and English. The French records were later sent to a different facility for English translation. Both English and French records were later transcribed by a different company.
The transcription coding scheme that included 89 items was developed based on various research questions and the data collected. Each transcript was analyzed by a research team member and an interviewer. A software analysis program, known as the Atlas.ti, was used to cipher transcribed data into concept categories so as to streamline the data obtained in the research. The researcher then compared the two analyses and combined them to come up with the final coded interview.
The researcher used the observation guide during the interviews in order to document the interactions of the different clinical staff with the EMR. The observation guide also included a set of questions so as to help in the observation process, which included the 4Ws. The questions were as follows:
1. When is the EMR used?
2. What functions of the EMR are being used?
3. Who is using the EMR?
4. What are its advantages and disadvantages, and how is doctor the interacting with the patient while using the EMR?
In addition, a case study report template was used by the researcher in documenting the final report. It had various sections such as the methodology, abstract, limitations and challenges of the research, workflow and process changes, EMR capabilities and use, and organizational impact, which was divided into clinical practice and workflow. It also included sections on future plans, lessons learnt from the study, the main success factors to the study, and discussion and conclusions. There was a clinical sketch included to show the tripartite encounter between the patient, doctor, and the computer screen.
Conceptual Framework
Data Collection
Raw data was collected from a total of 20 clinics through surveys carried out previously, direct observations as well as interviews with key persons. The clinical setting was the main unit for analysis.
Thematic Analysis
Qualitative methods were employed to undertake thematic analysis of information collected from site visits so as to enable the researcher to successfully answer the research questions.
Filtering Conceptual Framework for Knowledge Transfer
In conducting the study, we strived to validate the findings using an EMR meta-framework analysis. The study would be utilized to achieve knowledge transfer for the second research question: “How can EMR use be increased and sustained?” As such, information incentives was chosen as the success factor because it was potential to offer a more in-depth analysis. The choice of the above incentive was mainly based on our research as it was evident that no clinic would desire to return to manual system where they use paper-based charts after experiencing EMR in the facility.
The 12 questions included in the interview template related to information quality, a subcategory of 20 items from our 90-item transcription-coding scheme, as well as questions based on EMR adoption. The 20 items that resulted from the 90-item transcription coding scheme pertained to quotes from doctors who had experienced the value of EMR in greater information gathering from patients relative to the old manual paper-based system.
Results
References
Ravitch, S. M., & Riggan, M. (2012). Reason & rigor: How conceptual frameworks guide research. Thousand Oaks: Sage Publications.
Scott, T. (2007). Implementing an electronic medical record system: Success, failures, lessons. Abingdon: Radcliffe.
Skolnik, N. S. (2011). Electronic medical records: A practical guide for primary care. New York: Humana.
Walker, J. M., Walker, J. M., Bieber, E. J., & Richards, F. (2005). Implementing an electronic health record system. London: Springer.
