EMR adoption in Dhaka, Bangladesh: a template to index pediatric central nervous system tumor care and a review of preliminary neuro-oncologic observations

Abstract

Purpose To describe the design, implementation, and adoption of a simplified electronic medical record (EMR) and its use in documenting pediatric central nervous system (CNS) tumors at a tertiary care referral hospital in South-East Asia. Methods A novel EMR, cataloguing pediatric CNS tumors was used to collect data from August 2017 to March 2020 at National Institute of Neurosciences and Hospital (NINS&H) in Dhaka, Bangladesh. Results Two hundred forty-nine pediatric patients with a CNS tumor were admitted to NINS&H. Fifty-eight percent of patients were male, and the median age was 8 years. A total of 188/249 patients (76%) underwent surgery during their index admission. Radiographic locations were known for 212/249 (85%) of cases; the most common radiographic locations were infratentorial (81/212; 38%), suprasellar (45/212; 21%), and supratentorial (29/212; 14%). A histopathological classification was reported on 156/249 (63%) of patients' cytology. The most common infratentorial pathologies were medulloblastoma (22/47; 47%) and pilocytic astrocytoma (14/47; 30%). The median time between admission and surgery was 36 days, while the median post-operation stay was 19.5 days. Conclusions The feasibility of a basic EMR platform for a busy pediatric neurosurgery department in a lower-middle income country is demonstrated, and preliminary clinical data is reviewed. A wide variety of pediatric CNS tumors were observed, spanning the spectrum of anatomic locations and histopathologic subtypes. Surgical intervention was performed for the majority of patients. Barriers to care include limited molecular diagnostics and unavailable data on adjuvant therapy. Future targets include improvement of clinical documentation in the pre-operative and post-operative period.

The impact of limited access to electronic medical records on neurosurgical care within the CARICOM countries: A survey and scoping review

“…found that there was skepticism among clinical providers and hospital administrators regarding aspects of EMR, thus requiring extensive pre-implementation meetings, focus groups, and discussions to address the feasibility and acceptance of implementing this tool in the hospital ( Dasari et al., 2016b ). Hesitancy among stakeholders was also noted in other articles, pointing out the competing demands on neurosurgeons’ time to use a new system and simply not being prepared to adapt to this system ( Mukherjee et al., 2022 ; Williams and Boren, 2008 ).…”

“…A total of 14 articles were included in this scoping review ( Luan et al., 2021 ; Shapiro and Kamal, 2022 ; Ferry et al., 2021 ; Dasari et al., 2016a , 2016b ; Grant et al., 2021 ; Yancey et al., 2019 ; Mukherjee et al., 2022 ; Williams and Boren, 2008 ; Gyedu et al., 2015 ; Spence et al., 2019 ; Meara et al., 2015 ; Rock et al., 2020 ; Quinsey et al., 2018 ) ( Table 4 ). Three overarching themes were identified: (1) the overall benefit of EMR usage is substantial; (2) extreme barriers to implementing EMR systems in LMICs exist; and (3) there is a direct correlation between research efforts and EMR usage.…”

“… Improves clinical outcomes; enhances both data collection and process monitoring. Mukherjee et al. (2022) Child's Nervous System South Asia Flagged records to assist in data collection, correction, or verification Long term financial cost decreased Allowing better assessment and ability to identify areas that need improvement Competing demands on neurosurgeon's time Local technical support; cost of system maintenance; increased cost of EMR with greater provider utilization High start-up cost and design cost Corrupted or locked records; incorrect or incomplete data entry Enhanced analytic and research capabilities.…”

“…However, EMR systems have been shown to support patient follow-up and allow for remote consultations ( Yancey et al., 2019 ). In a study describing the design, implementation, and adoption of an EMR system by the pediatric neurosurgical department at the National Institute of Neurosciences and Hospital in Dhaka, Bangladesh, patient tracking, hospital discharge, and outpatient follow-up were easily managed after EMR implementation ( Mukherjee et al., 2022 ). This can be attributed to easier monitoring of a patient's record; when there is only one chart in an EMR system it can link records from repeated visits and maintain all patient information in one location ( Grant et al., 2021 ; Williams and Boren, 2008 ).…”

“…Adequate funding is needed for hardware, EMR software, implementation assistance, training, and ongoing network fees and maintenance ( How much is this going, 2014 ). Though funding may present initially as a barrier to EMR implementation, through data-based quality improvement initiatives that save time and money and improve patient care and outcomes, Mukherjee and company point out there is a long-term cost benefit to using EMR( Mukherjee et al., 2022 ). Irrespective of the financial costs, the lack of infrastructure to sustain EMR systems makes implementation challenging.…”