Best Practices for Implementing EMRs at the primary care level

The use and adoption of information technology (IT)-based applications in healthcare and particularly electronic medical records (EMRs) has been on the rise over the past two decades. Both primary and secondary healthcare facilities, that traditionally recorded patient records manually, have embraced EMRs for recording patient data and overall patient care management. Nowadays, it is almost hard to imagine healthcare without IT-based applications for the collection, analysis, storage and use of patient clinical information. This is in part because IT has been recognized as an “enabler”, in addressing world’s most pressing challenges.

Several studies have shown that EMR interventions have led to improved quality of care provided, reduced medication errors and improved communication and interaction between patients and the care providers, which in turn results to improved patient outcomes and strengthened public health system

This article highlights best practices that can be adopted to increase the adoption, utilization and usability of EMRs at the primary care level.

As with other technological innovations, adoption of interventions such as the EMR take time to materialize. However, if the following factors are considered, then adoption becomes rather much easier.

1. Central Data Repository – Establish a central repository that will allow sub-county access to data for decision making, perform data quality checks and retrieve reports during supportive supervision and conduct disease surveillance. The central repository will also help in establishing a client registry for the sub-county/ county which in turn helps determine the correct baseline population. The central data repository also serves as a backup system.

2. In-built dashboards for data analysis and use – Incorporate dashboards in the EMR to support data analysis, interpretation and use at the facility level to strengthen their decision making capacity in responding to matters of public health concern

3. Automate all service points – Ensure the EMR automates all service points at primary care facility. The EMR should contain modules for outpatient department (OPD), Laboratory, Pharmacy, Inventory management, Immunization, Family Planning, Antenatal Care (ANC), Child Wellness Clinic (CWC) and Maternity modules. The EMR should generate reports for all the modules.

4. EMR should have in-built data quality assurance & quality control mechanism

5. Integration with DHIS2 – such that reports generated by EMR are automatically submitted to DHIS2. Integrate patient data across facilities implementing a similar EMR within a specified geographical location (e.g. ward, district etc.)

6. Have locally-based developers –Have locally-based developers to promptly address change requests made. Also ensure prompt technical support

7. End user engagement Engage the end users before modifying or addigng new system features. This will improve

8. EMR should promote timeliness and completeness KPIs for HMIS reporting

9. Training – Provide continuous refresher training and prompt on-job-training for new staff.

10. Feedback process Establish adhoc communication channels such as WhatsApp groups to serve as feedback forum