Implementation of electronic medical records at an Emergency Medicine Department in Tanzania: The information technology perspective

Abstract

In 2015, the Emergency Medicine Department at Muhimbili National Hospital (MNH) installed and implemented the first Electronic Medical Record (EMR) tailored to the emergency centre (EC). The EMR deployed was designed for emergency centre use only (Emergency Department Information System (EDIS)) and linked with the existing EMR that focused on registration and billing. This very collaborative experience can be used as a reference to share the many lessons learnt by all, including hospital management, EC staff, private funders and EMR vendors. The IT Project Plan was developed to make sure steps were followed for EDIS implementation. This included the IT plan documents, specific user requirements, development of a Memorandum of Understanding and user manuals. Super key users were identified among the staff during the training and they helped to empower staff, consolidate knowledge and share the workload. Several challenges have been overcome, including when the power was not regulated so an automatic generator and uninterruptible power supply (UPS) devices installed to protect all computers. Providers were primarily a very novice group of computer users and many had little to no computer experience so were taught both basic computing skills and EDIS specific tasks. Trained staff were moved around the hospital and a lot of time was taken up training new staff, so discussion with hospital management led to retention of staff in the EC. Specific templates have been introduced to ensure adequate minimum documentation. However, even with these, clinical notes are often very brief and we are searching for further mechanisms to improve this. Hospitals in low-resource settings considering the implementation of an EMR should ensure that a comprehensive plan is in place that involves significant staff training, improvement of existing, or installation of new information technology systems, ongoing ICT support and funds for unforeseen issues and ongoing maintenance.

South African and international legislature with relevance to the application of electronic documentation in medicolegal autopsies for practice and research purposes

“…The legal and ethical implications of publication of electronic records are an important consideration as social media becomes a standard method of communication (Tonder 2013;Eoghan Casey 2011;Bouter et al 2020;Leroux 2004;Fourie 2016). The involvement of various stakeholders is also integral to the continued and sustained implementation of electronic health records in resource poor settings, especially in the implementation of the National Health Insurance in South Africa (Wilson and Khansa 2018;Katurura and Cilliers 2018;Lucas et al 2019;De Pietro and Francetic 2018;Zayyad and Toycan 2018;Mashoka et al 2019). Insight driven research supported by the implementation of electronic records have substantial benefits, which include and may not be limited to improving the quality of healthcare service.…”

“…This is despite many benefits of implementing an e-system as reported in a study in a developing country setting (Mashoka et al 2019). The involvement of various stakeholders is also integral to the continued and sustained implementation of electronic health records in resource poor settings (Wilson and Khansa 2018;Khubone et al 2020;Katurura and Cilliers 2018;Mashoka et al 2019).…”

“…The factors include the lack of information technology infrastructure to support the implementation; the need for commitment to user training and processes; the importance of political influence or strategy on its implementation; the necessity of updated legislation and regulations relating to electronic records; and the lack of a framework for implementation and management of electronic health records (Katurura and Cilliers 2018). This is despite many benefits of implementing an e-system as reported in a study in a developing country setting (Mashoka et al 2019). The involvement of various stakeholders is also integral to the continued and sustained implementation of electronic health records in resource poor settings (Wilson and Khansa 2018;Khubone et al 2020;Katurura and Cilliers 2018;Mashoka et al 2019).…”

“…If this trail of information is continuously audited to maintain credibility, its admissibility in court may not be questioned. It has been shown in low resource settings that the use of electronic and cellphone records have an important positive effect on the accessibility of information (Mashoka et al 2019). Accessibility to information will create a valuable and hospitable platform that is conducive to research.…”

Towards interoperable e-Health system in Tanzania: analysis and evaluation of the current security trends and big data sharing dynamics

“…The ministry is ambitious in completing the Tanzania Health Enterprise Architecture (THEA) to guide in development of national integrated HIS [83]. Currently, the framework has been used to design a HIS called Electronic Facility Management System (eFMS), which will be implemented in majority government hospitals in Tanzania in phases [84]. There are two phases towards implementation of the HIS with Phase 0 aiming at developing Hospital Management Information Systems (HoMIS), warehouse for data, and National Health Insurance Fund (NHIF).…”