Electronic Health Record System (EHRS)

Abstract

Background: Electronic Health Record System (EHRS) is used largely in developed countries, though developing countries have also implemented the system in their healthcare industries. The electronic health record system (EHRS) is expected to improve the quality of patient care, and its successful implementation depends on the clinical perception of EHR systems. Many medical staff have resisted digitalization, observing the system as uncaring, confusing, and dehumanizing. The literature showed physicians’ perceptions and attitudes toward the significance of the system in improving healthcare facilities but also identified the factors influencing the resistance to using the new system.

Research Question:

Do healthcare professionals perceive that the use of electronic health records improves the quality of healthcare services in healthcare organizations in Gulf Cooperation Council Countries?

Objective: Systematic research was conducted to evaluate the physicians’ perceptions and satisfaction with the newly implemented EHRS in healthcare organizations to improve the quality of healthcare services in Gulf Cooperation Council Countries.

Method: A systematic literature review is used to examine the physician’s and medical staff’s attitudes, knowledge, satisfaction, preferences, and perception of the Electronic Health Record system. The study was focused on physicians, pharmacists, receptionists, medical staff, and nurses working in various hospitals in Gulf countries such as Saudi Arabia, Bahrain, Kuwait, UAE, and Oman. The literature review concentrated on government and private hospitals in different regions of Saudi Arabia, i.e., Makkah, Jeddah, Taif, and Riyadh. In Oman, Bahrain, Kuwait, and UAE, several clinical specialists, public hospitals, and primary healthcare centres were investigated.

Result: The overall response of physicians and other medical staff’s perception and satisfaction towards using EHR systems to improve healthcare services was positive. However, the study identified a negative perception of the system in Saudi Arabia, mainly because of the lack of sufficient technical training and personal preferences.

Conclusion: The majority of the studies specified the positive perception and high satisfaction rates toward the newly implemented computerized record-keeping system. Physicians agreed on the useful impacts of using electronic health record systems to reduce errors and maintain a proper record of patients, especially in diseases like HIV, which require constant medical treatment and assistance. The review also revealed the barriers and factors influencing the adoption of EHRs in hospitals and medical care facilities. Two major barriers identified to hinder the successful implementation and adoption were human barriers related to knowledge gaps, personal beliefs, and financial barriers related to the high cost and insufficient funding to implement EHRs in developing countries.

Literature Review

Introduction

An electronic health record system is a digital form of a patient’s paper chart (McDonald, Tang, and Hripcsak, 2014). It is widely used in any healthcare organization to collect patient data such as medical history, prescribed medication use, and demographic information. Developed countries such as Canada and the United Kingdom have a national EHR system. In 2012, 72% of office-based physicians in America used EMR/EHR systems (Hsiao and Hing, 2012). Keeping health records digitally is undergoing a transition not only in developed countries but also in developing countries.

The developing countries lack a well-organized healthcare infrastructure to effectively fight against Malaria and Human Immunodeficiency Virus (HIV), among other deadly disease that requires constant medical assistance and treatment. Basic paper-based record keeping is not enough and needs to be replaced by a new, innovative electronic health record system (Kalogriopoulos et al., 2009).

The study aims to investigate the physician’s perception of the impact of using electronic health record systems (EHRS/EMRS) to improve the quality of healthcare services in Gulf Cooperation Council countries. The literature review reflects the most current and pertinent research available on electronic health record systems in Gulf countries. In Saudi Arabia, the Saudi Ministry of Health (MOH) has taken initiatives to implement EMRS nationwide. According to research conducted by Shaker, Farooq, and Dhafar in 2015, 52.8% of physicians appreciated EHRS positively in Saudi Arabia. However, there is a deficiency of awareness about the use of EHR systems among a range of administrative staff and health professionals (Hasanain, Vallmuur, and Clark, 2015).

EHR is an assisting technology that lets physicians apply quality improvement processes in the practice of medicine. The systems provide accuracy of the information, speed of communication, date revision, and data retrieval, and improve adherence to clinical practice guidelines in healthcare facilities (Al Alawi et al., 2014). The computerized clinical record system is useful for the storage of a huge volume of regulatory information administrative and clinical information. These systems not only provide speed and accuracy but also decrease the rate of medical error, increase quality, and fulfil regulatory audits. Physicians see the digital system as a means to advance quality care and increase cost efficiency (Al Farsi and West, 2006). It is a new way of communication and interaction among paramedical employees, nurses, and physicians. EHRs are reducing medical costs by eliminating inappropriate care, inefficiency, and medical errors (Fleming et al., 2014). The system is also capable of detecting unusual patterns such as a high number of lab investigations ordered by physicians, oddly high degrees of hospitalization, or patient readmission.

The successful use of electronic health record systems is crucially dependent upon the clinical perception of EHRs. The literature review of nine articles from different countries in the Middle East is focused on determining the physician’s satisfaction and perception of the electronic health record system. The study conducted in the United Arab Emirates (UAE) concluded that physicians are satisfied with the system and have an affirmative perception regarding the application (Al Alawi et al., 2014). Similarly, researches conducted in Saudi Arabia indicate the positive attitude of nurses toward EHRs (Alzobaidi et al., 2016), and they agree on the benefits of using this system (Asiri, AlDosari, and Saddik, 2014). An article from Taibah University of Medical Sciences in 2014 stated that physicians’ dissatisfaction with the digital system was significantly associated with its performance and the quality of the information (Youssef et al., 2014). Another study showed an increasing adoption of EHRs in Saudi Arabia; however, it indicated that computer training and literacy rates are directly proportional to clinical efficiency and EHR satisfaction (Alasmary, Metwally, and Househ, 2014).

Two types of research conducted in Kuwait have shown a very positive perception of EHRs by physicians and their confidence in the efficiency and accuracy of EHR systems (Al Azmi et al., 2008). The majority of physicians who participated in the study reported that the EHR system was easy to use (Al Azim and Al Saleh, 2008). However, In Oman, physicians indicated low satisfaction with the current EHR system because of its inadequate and inappropriate usage (Al-Mujaini et al., 2011). Most of these studies showed a positive attitude and high satisfaction of physicians with electronic health record systems; however, there are several barriers and challenges involved in the adoption of a digital system.

Adopting new technology is always challenging. Nurses are the largest healthcare personnel in critical care facilities; therefore, nurses’ advocacy of the electronic health record system is a crucial factor in promoting its implementation. The process of adopting EHR systems is growing rapidly within the healthcare industry. The Medical secretaries and the nurses interact with EHR systems as receptionists, transcriptionists, and nursing diagnoses, write nursing care plans, check physician orders, and record vital signs. This makes them the primary users of the system, but the evaluation of EHRs by nurses has received less devotion (Mahalli, 2015).

The major barriers identified by several researchers that hinder the successful implementation and adoption of health information systems in Saudi Arabia are human barriers and financial barriers (Khalifa, 2014). Human barriers refer to the healthcare professional’s knowledge, personal beliefs, and attitude regarding health record adoption (Mahalli, 2015). Financial barriers include insufficient money and funding to implement the EMR system.

The studies investigated the barriers and factors affecting user satisfaction with electronic health record systems and concluded that physicians agree with the usefulness of digital systems in recording medical history, but adopting new technology is challenging. Computer literacy and training can improve satisfaction. Another important element to improve the physician’s adoption of the system is the involvement of the primary users in developing the EHR system and asking for recommendations on how to improve the interface. The implementation of a computerized system is not as challenging as providing the maintenance and technical support to sustain the system. Low-budget countries face difficulties in technically maintaining the system and thus indicate the need for improved technical training.