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What non-technological factors make EMR effective?

By Jonathan Payne | 20 May, 2010 Last edited by Joaquin Blaya, PhD on 09 Aug 2010

This post is part of the Effective EMR: Beyond the Technology discussion, based on content from the Global PHAT 2010 Conference. To get some background on the topic, the session video and presentations from Hamish Fraser, Mike McKay and Bobby Jefferson are available in this related resource: http://www.ghdonline.org/tech/resource/global-phat-effective-emr-moving-beyon...

For the first question, we will take a look at the fundamental premise that EMR is an enabling technology that requires additional steps in order realize improvements in quality or increases in efficiency. Is this premise correct? What are specific examples you have been involved in of making EMR effective and what steps (especially steps outside of software updates) did you take to get there? Some examples of steps might be related to updating clinical workflow, recruiting a particular person to champion a project, modifying training programs, creating a new working group, etc.

Attached resource:
  • Global PHAT - Effective EMR: Moving Beyond the Technology (download, 3.2 MB)

    Summary: Electronic medical record systems (EMR) are an enabling technology that can be leveraged to increase efficiency or improve quality of care. The technology itself, however, is often less important than the non-technological factors in determining the success of an implementation. Factors include information and clinical workflows, training and support, organizational priorities, funding, and form design.

    Global PHAT 2010 on May 1 at the Harvard Kennedy School included a panel entitled Effective EMR: Moving Beyond the Technology (www.globalphat.com/panel2.html). The panel was moderated by Jonathan Payne begin_of_the_skype_highlighting     end_of_the_skype_highlighting, graduate of Harvard School of Public Health. Panelists included:

        - Hamish Fraser, Director of Informatics & Telemedicine, Partners in Health
        - Bobby Jefferson, Senior Health Informatics Advisor, Futures Group
        - Mike McKay, Former Country Director, Baobab Health Malawi

    PHAT has partnered with GHDonline.org to continue the discussion of these important topics in the Health IT Discussion Forum. Take a look at the video below and the attached resources and participate in the discussion at GHDonline.org.

    Related discussions:
    What non-technological factors make EMR effective? (http://www.ghdonline.org/tech/discussion/what-non-technological-factors-make-...)

    Source: Public Health & Technology Forum

    Publication Date: May 1, 2010

    Language: English

    Keywords: Baobab, Conferences & Meetings, EMR, Global PHAT, health information technology, IQCare, OpenMRS



Joaquin Blaya, PhD Moderator Replied at 12:33 PM, 22 Jun 2010

This is a really good and very broad question that many organizations are still figuring out. Even in developed countries, the rate of failure ie stopping to use a system or having it require much more cost and time to implement EMRs has been estimated to be between 30-60% by some authors.
The topics mentioned in original question are all really good points and usually a necessary part of implementing a system. My experience has been with implementing a laboratory reporting system for Tuberculosis to communicate lab results from regional labs to approximately 250 health centers in Lima, Peru. Here’s the article we wrote on our experience implementing the systems (http://www.biomedcentral.com/1472-6947/7/33).
What I wanted to highlight from the article where 3 things.
1. Having a local organization that has been on the ground working in the clinics or laboratories helped tremendously in being able to implement the information system there was already trust that our organization knew what it was doing and also the IT system was part of a larger project that had been on the ground for the last 2 years.
2. A local champion is key. We had a Peruvian clinician who knew how the system worked and who was the appropriate person to talk to in order to get and keep the project going.
3. Local appropriation of the system. In our case, this included putting a local name to the system (e-Chasqui, after the Incan runners), asking local clinicians and nurses their opinion about the system, and helping health centers when they had problems with the system or other things, such as internet or contacting the lab so that they would input a result.

There are many other factors, that I’m sure others can expand on, but these were the three most important for this implementation.


Naomi Muinga Moderator Replied at 3:19 AM, 6 Jul 2010

I have recently been involved with the implementation of an EMR at a local district hospital.
The system was initially meant to be used by doctors as they admit patients.
In terms of technical support,we had regular visits to the sites mostly preceeded by telephone calls to discuss pressing issues.
Among the things we had to do in order to encourage use of the system are:
1. Change the workflow to include nurses who were also very interested in using the system. Hence we had to design a portion of they system to suit these needs.

2. We had to appoint a champion(a clinician) at the hospital who would be the first contact person in case any issues arose. The champion would then contact us(developers) when there were issues that could not be resolved locally.

We are still in the process of learning more about the implementation experience and how we could make it more efficient in the event that we have to do it at another site.


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