Christopher Tufton | Electronic health records, wave of the future
In the shadow of the recent pandemic and given the changing face of the population’s health profile, strengthening health systems has never been more important nor required more urgent attention than right now.
At the Ministry of Health & Wellness, we are giving it that attention by aggressively pursuing a comprehensive plan for the reform of the public health system.
Essential to this effort is building the capacity to respond to shocks, the likes of which we saw with COVID-19; and to recover from them while providing better services and safeguarding continuity of care, as well as more equitable access to care for all.
The introduction of an Electronic Health Records (EHR) Management System is an important early step, as we utilise technology to streamline and create greater efficiency within the health system.
Jamaica has received loan financing to the tune of US$50 million from the Inter-American Development Bank towards the cost of the Support for the Health Systems Strengthening for the Prevention and Care Management of Non-Communicable Diseases programme. A portion of that sum has been applied to the acquisition of the EHR Management System.
EHR is a fundamental building block of the modern practice of healthcare delivery. It begins with the philosophy of ‘one patient, one record’, which means that patients’ full medical history is put on a database and ‘goes’ with them as they access healthcare along the life course, whether at a health centre or hospital.
Having this one health record means that healthcare providers are put in a position to review, on the demand, a patient’s medical history for more timely and effective assessment and treatment. Jamaica, by implementing this system, will be on the cutting edge of healthcare delivery.
The system will boast features that include a patient registration system for the appointment setting and assignment of patients in the triage process; and the seamless interface of critical diagnostic imaging that will enable doctors to see X-rays and CT scans on computers and tablets provided to the various health facilities.
Ultimately, the EHR allows for easier documentation and recall of vital patient information when compared to the paper record or “docket”. It also increases efficiency by reducing waste and complexity inherent to the paper record. In addition, it allows for quicker access to results and other clinical data due to integration with lab and radiology systems.
The system is also designed with the capacity to produce reports on the operational efficiency of facilities and will be able to provide information to the doctor, the patient, the management of the facility, the regional health authorities, the ministry and, ultimately, the Parliament of this country in terms of service delivery and standards of care being provided.
Cabinet has now approved the award of the EHR contract to The Phoenix Partnership (Leeds) Ltd in the amount of US$5 million (J$5,029,221.24). This is the first technology-driven element of its kind in Jamaica and the Caribbean region; and Jamaicans who use our public health system will benefit in myriad ways.
COVID has taught us that there is an urgent need for enhanced integration of health systems where data management and information technologies can be used to treat patients remotely through telemedicine or through immediate access to their health history.
This is rooted in the Information Systems for Health Framework that is an integrated effort for the convergence of interconnected and interoperable systems, data, information, knowledge, processes, standards, people, and institutions. This is all supported by ICT that interact to generate, identify, collect, process, store, and make free and publicly available, quality data and strategic information for better policy- and decision-making in public health systems.
The National Plan for the Information Systems for Health of Jamaica adopts cost-effective ICT tools and solutions. The first component of the National Plan regarding information technology is the EHR Management System. Of note is that this includes a range of data management activities – demographics, medical history, medication and allergies, immunisation status, laboratory test results, radiology images, vital signs, personal statistics like age and weight, and billing information. It will also address disease registries and health records in which health data and information maintenance will be shared by patients and providers.
There are those among us who may query the confidentiality of patient records. We take this seriously and so our efforts will be guided by the Data Protection Act. Practically, however, the EHR Management System will provide more security than a data room where paper files are kept.
The 18-month implementation period for the contract will, in the first instance, see the roll out of the EHR in 10 health centres and three hospitals. That first phase will then be assessed and followed by other phases which are expected to benefit other facilities.
At the ministry, we also understand that any implementation of this nature must be accompanied by a significant change management strategy supported by a well-resourced implementation plan.
The implementation of the EHR will, no doubt, result in changes in the way people work, how the doctor relates to the patient and how he or she relates to the information that is now being provided on a computer screen, monitor or tablet. We therefore have to prepare our people for that. After all, technology without the support of our people can invariably limit the benefits from the technology.
The contract for the project therefore involves training and change management initiatives to move doctors and nurses from paper-based to technology-based operations. The change will also affect how records are collected, stored and managed within health facilities. It is not the intention to separate persons from their jobs, but we will re-examine the processes and procedures around how work is done in facilities and some jobs will need to be redesigned to meet the new and evolving needs of the workspace.
The EHR represents another significant milestone on the journey to strengthening our health system for the benefit of all Jamaicans, and in keeping with our commitment to transform public health. We urge all stakeholders to support us in this endeavour.