The Role of EHR in improving the quality of patient care in the critical area (ICU) of Kenya.

Chapter 1: Introduction

1.1 Background of the Research

In a bid to improve efficiency and effectiveness to which medical services are provided, governments have sought to the deployment of information technology systems in healthcare facilities, data collection, storage and retrieval. As such, Electronic Health Record (EHR) systems have been in place in several developed countries and over the years been adopted by developing countries like Kenya (Fraser HS et al., 2005). An Electronic Health Record is a real-time digital medical record of a patient, maintained by healthcare facilities, containing a range of data including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics and billing information (Gunter et al., 2005). Automation of these records eases its access because it allows for sharing across enterprise-wide information systems. Its purpose goes beyond the storage of standard clinical data as it allows for the provision of evidence-based tools that healthcare providers can use in decision making about a patient’s care and automation and streamlining of healthcare providers’ workflow thus improving quality of outcomes from the care management programs issued (HealthIT.gov, 2019).

When it comes to the quality of care, it is defined by IOM as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge”. To achieve desired health outcomes in intensive care, certain aspects have to be implemented, including establishing standards of care, monitoring processes and outcomes, creation of multidisciplinary teams, data recording as part of routine care and automated retrieval of information using technology. EHR makes records readily available at point of care, allowing for the delivery of better patient care (Lisa et al., 2012).

In Kenya, EHR use has majorly been linked to specific diseases; for example, it is used within projects that mainly support HIV care (Oluoch T et al., 2016). Much as these implementations were successful, there is more benefit, especially in intensive care, that remains untapped when it comes to putting to use EHR’s potential.

1.2 Problem Statement

Since the adaptation of EHR systems, numerous reviews have been issued on the systems not to address the minimum functional requirement categories which the EHR Standards and Guidelines for Kenya deem important for defining standards for EHR systems. With EHR systems being the current way of hospital management and also delivering healthcare in some healthcare facilities in Kenya, there is a need for a review of their role in ICU. This study intends to ascertain the effect of EHR implementation on the medical intensive care unit (MICU) in improving outcomes in the Kenyan healthcare facilities.

1.3 Research Objectives

1.3.1 General Objective

To determine the impact of EHR on healthcare delivery in critical care facilities in Kenya.

1.3.2 Specific Objectives

1. To determine the types of EHR systems used in Kenya.
2. To evaluate the functions of EHR systems in critical care
3. To determine the benefits of EHR systems in critical care in Kenya

Chapter 2: Literature Review

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2.1 Introduction

EHR systems with computerized physician order entry have become exceedingly common, and government incentives have urged its implementation. The purpose of this study is to ascertain the effect of EHR implementation on medical intensive care unit (MICU) mortality and length of stay (LOS).

2.2 EHR Systems Being Used

The most widely used EHRs by physicians according to Medscape’s EHR report are Epic with 23%, Cerner with 9%, Allscripts 10%, eClinicalWorks with 6% and NextGen with 6%. In Kenya, the HER or EMR systems used in various private and public hospitals include Comprehensive Patient Application Database (CPAD), IQ Care, Care 2000, Funsoft, Compact, Open Medical Record System (OpenMRS) among others.

2.3 Functions of EHR in Critical Care

According to a study by Thompson G et al., EHR implementation has significant effects on mortality rate in critical care. This is based on results of a study on use electronic patient records stored over time which reduced the mortality rate from 43 risks of death in every 281 patients, who were admitted before EHR implementation, down to 26 per 269 patients, 8 months post-implementation of EHR. This is credited to EHR’s functionality that enables physicians to identify and work with patients to manage specific risk factors or combinations of risk factors to improve patient outcomes by having timely access to accurate and complete patient information.

The second major role of EHR in critical care in on the MICU LOS. With EHR making records readily available at point of care, the same study at the urban teaching hospital in Atlanta resulted in a statistically decreased LOS data from 4.03 ± 1.06 days for the patients administered to before implementation of EHR to 3.26 ± 1.06 days 4 months post-EHR and to 3.12 ± 1.05 days 8 months post-EHR (P = 0.002) (Thompson G, O’Horo J.C, Pickering B.W et al., 2015).

2.4 Impact of EHR Systems in Critical Care in Kenya

Taking into consideration that most healthcare problems are universal the risk of the worst-case outcome is subjective based on one’s health history, implementation of EHR in Kenyan Healthcare facilities’ critical care units will benefit from increased survival rates and a decrease in the length of stay in ICU and generally improved ICU outcomes.

Chapter 3: Research Design

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3.1 Research Type

This research will use quantitative research to confirm medical assumptions and establish generalizable facts about the effects of implementing EHR on general healthcare outcomes. Primary sources of data will be collected based on medical records statistics. Lastly, correlational research will be used to measure the relationship that exists between the two variables that affect healthcare outcome, that is the implementation of EHR and a lack thereof, in ICU.

3.2 Sources

The study will be done on patients in critical care of healthcare facilities in Kenya, subjects selected through case study method to give a detailed view on this specific subject of clinical research and this will be done over a period of 8 months.

3.3 Research Methods

The tools and procedures to be used are observation and records review because these are the main ways to collect patients records over time and analyze care outcomes based on history.

References

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electronic medical record systems in developing countries. Inform Prim Care. 2005;13(2):83–95.

Gunter, T. D., & Terry, N. P. (2005). The emergence of national electronic health record

architectures in the United States and Australia: models, costs, and questions. Journal of Medical Internet Research, 7(1), e3.

HealthIT.gov. (2019): What is an Electronic Health Record (EHR)?:

https://www.healthit.gov/faq/what-electronic-health-record-ehr

Kenya Ministries of Health (2010) Standards and Guidelines for Electronic Medical Record

Systems in Kenya. Nairobi: Kenya Ministries of Health.

Oluoch T, Katana A, Kwaro D, Santas X, Langat P, Mwalili S, Muthusi K, Okeyo N, Ojwang

J, Cornet R, Abu-Hanna A, de Keizer N. Effect of a clinical decision support system on early action on immunological treatment failure in patients with HIV in Kenya: a cluster randomized controlled trial. Lancet HIV. 2016 Feb;3(2):e76–84. doi: 10.1016/S2352-3018(15)00242-8. http://europepmc.org/abstract/MED/26847229.

Thompson G., O’Horo J.C., Pickering B.W. et al. Impact of the Electronic Medical Record

on mortality, length of stay, and cost in the hospital and ICU: a systematic review and meta-analysis. Crit Care Med. 2015; 43: 1276-1282