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Electronic Medical Records
Electronic health record (EHR) systems record health-related information on an individual so that it can be consulted by clinicians or staff for patient care. One formal definition of an EHR is “an electronic version of a patient’s medical history, that is maintained by the provider over time, and may include all the key administrative and clinical data relevant to that person’s care under a particular provider, including demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data, and radiology reports” (CMS, 2016).
The EHR has the potential to streamline the clinician’s workflow and to support evidence-based decision support, quality management, and outcomes reporting (Safran et al., 1993; Bates et al., 1998; Kaushal et al., 2003). However, implementation of EHRs can be slow, expensive, and have usability problems (Koppel, 2010; Jamoom and Hing, 2015; Jha, 2011; Kushniruk et al., 2013). In the United States the Department of Veterans Affairs (VA) has developed and deployed the Vista Electronic Health Record system (Evans et al., 2006). Formal evaluations of EHR in developing countries have shown successful implementation. For example, the Indian Health Service’s Vista system showed that the majority of clinicians viewed its implementation positively and hence used it more (Sequist et al., 2007). The Mosoriot Medical Record System evaluation in Kenya showed improved staff productivity and reduced patient wait times (Rotich et al., 2003). OPENMRS system is an open source freely available system that has been implemented in Africa (Seebregts et al., 2009), Haiti (Fraser et al., 2004), and Peru (Fraser et al., 2006).
Laboratory information management systems are used to report results to administrators and healthcare personnel. These systems can potentially decrease the time to communicate results, reduce errors, and improve the productivity of a laboratory. These systems have also been deployed in low-resource settings, such as a system in Peru (Blaya et al., 2007), where despite some challenges, such as a limited number of trained personnel, the system was deployed across a wide region.
Pharmacy information systems can be used to order, dispense, or track medications or medication orders, including computerized order entry systems. A systematic review (Robertson et al., 2010) of the impact of computerized pharmacy order entry systems and clinical decision support systems described how usage of these systems resulted in improvements in safety concerns such as drug interactions, contraindications, dose monitoring, and adjustment. These systems can also be used to determine if medication is being prescribed according to clinical guideline recommendations. This study noted that without good communication between pharmacists and physicians, the full benefits of this type of system may not be realized. Developing countries are also deploying these systems. A case–control study of a pharmacy information system in Mexico showed an increase of 41% of patients handled and 28% in the number of tests processed (Alvarez Flores et al., 1995). Training and communication processes are critical issues in the successful implementation of these systems.