Health Provider Readiness As A Key Metric Of The Adoption Of Electronic Health Records in Africa

Clinics and hospitals have started building their own Electronic Medical Records(EMR) to collect and store patient data in the last few years. Gradually, we are seeing a shift from paper records to digital records. However, these data only reside in individual health facilities and cannot be transferred to others. EMR has proven to be just the digitisation of patient data and failed to meet its decentralisation call. In short, patients still fill out medical history forms afresh when they change health facilities. Hospitals are still operating in silos without any sustainability and innovation in decentralising patient data.

Hence, the need for an Electronic Health Record(EHR). An EHR is a repository of patient data in digital form, stored, exchanged securely, and accessible by multiple authorised users(which may include the patient). It promises improved healthcare quality and delivery. Yet, although it provides an easy way to access and aggregate clinical data for healthcare providers, it is not widely accepted and acknowledged in Africa.

Before we discuss the implementation of an EHR across the continent, we need to first understand the technology readiness of the healthcare system to adopt this technology. Technology readiness (TR) refers to “people’s propensity to embrace and use new technologies to accomplish goals in their home life and at work”. In the healthcare system, some domains to consider technology readiness are organisational readiness, technical and infrastructural readiness, healthcare provider readiness, engagement readiness, societal readiness, core readiness, governmental readiness and public patient readiness.

A core part is the healthcare provider readiness. Technology readiness may differ for physicians, nurses, and other health workers based on their experience and exposure to technology. Therefore, a mere roll-out of a significant technology may not necessarily contribute to a successful implementation.

Another point to note is that physicians are the primary frontline users of EHRs and impact the overall adoption. If they adopt and support EHRs, other healthcare workers like nurses, laboratory staff and administrative staff will be positively influenced to do the same.

The Usual Path Of Technology Adoption

Throughout the world, technology adaptation differs from person to person. Everett Rogers’ Diffusion of Innovations posits that technology adoption is generally in five phases — innovators, early adopters, early majority, late majority and laggards.

Innovators (2.5%) — These people are enthusiastic about new technology, are risk lovers and do not fear failure. They are typically the ones who upgrade their phones immediately after more recent models are released and are quick to download new apps or upgrade their operating systems. In healthcare, these are more likely to be the doctors and nurses in the late millennial and Gen Z category who grew up exposed to apps and technology. They will be the first people to use EHR and willing to show others.

Early Adopters (13.5%) — These are opinion leaders who are more discreet about the adoption of innovation. They love new technology, yet they want to form a solid opinion before they can directly support it. They will instead gather more information on innovation before recommending it to others. To wit, these are late millennial or older doctors who have their reputations at stake. Although open to adopting new technology, they will want to be sure about its efficacy before recommending and publicly supporting it. They will typically use EHRs, ask all their questions, suggest improvements and be open to beta testing before spreading the news.

Early Majority (34%) — They have contact with early adopters and have an above-average social standing. These people will wait to hear reviews of innovation from the early adopters before they jump on the bandwagon. They are logical, practical and data-driven. They will easily adapt a technology once their doubts have been dutifully cleared. Conventionally, these are doctors and matrons who would rather read journals and report on EHR and speak to other doctors about their experience before accepting it. They will research its importance based on real case studies of other countries and continents.

Late Majority (34%) — Usually sceptical and will only adopt the technology after the majority of people have adopted the technology. They will rather watch how change plays out before they join. They are cautious and do not like to take risks. They will be the people to adopt using EHR when it becomes compulsory.

Laggards (16%) — These people are traditional, change-averse and may be advanced in age. They would stick to what they know than try new ideas. This group will prefer to keep paper records safely in a fireproof room than accept digital records. They are sceptical and wary of change. Even if paper records are scrapped altogether, they will silently wait for a day the server will go down to have their ‘I told you so moment’.

Barriers of Adoption

Beyond the healthcare providers’ appetite for innovation, known barriers can prevent the widespread use of EHR if not addressed.

Cost

The costs of EHRs can be high, and healthcare providers usually wonder if it is worth the investment and whether they can gain a financial benefit from it. The cost goes beyond the fixed cost of purchasing the software to ongoing costs like operations, maintenance, support, governance etc. For those without a large IT budget, this can be a barrier to adoption.

Lack of Computing Skills

Many physicians, nurses and administrative assistants have insufficient knowledge to operate an EHR. Even basic typing skills are a challenge. This bottleneck encourages them to keep writing on papers which is easier and faster. Therefore, the EHR must be easy to use and operate with a simple user interface.

Security and Privacy

Most healthcare providers fear the temporary loss of data when there is a power failure or a computer crashes. To them, several technical faults can occur to wipe all patients’ data or expose the data to the wrong hands. The fear of reliability and security go hand in hand.

Time Factor

It requires time to buy and set up the EHR, time to move data from paper to EHR, and time to move data from EMR to EHR. It also requires time to learn how to use the EHR and become proficient. Finally, using the EHR takes more time per patient in the consulting room. Pausing to slowly type outpatient symptoms and diagnosis while consulting makes each patient session longer.

Using the Diffusion of Innovations phases, we have a glimpse of how adaptation will happen and how to tackle each group. We are also aware of all the barriers which prevent healthcare provider readiness. Moreover, as a people, the younger generation adapts to technology easier than the rest. However, the question remains — how can we get everyone ready and willing to move to this shift we desire?

How To Prepare Health Care Providers For Technology Readiness

With the phases of innovation adoption in mind, here are a few ways to prepare healthcare providers:

• Cultivating information technology skills during medical education and post medical education, including self-paced training opportunities.

We cannot underestimate the time required to become proficient in using EHRs for first-timers. Healthcare workers have to be trained adequately on how to use the platform and also have access to self-paced refresher courses. In addition to this, students preparing to be physicians and nurses must undergo a compulsory information technology course with specifications on operating an EHR.

• Assuring workers that adopting the technology will not change their work habits dramatically

Healthcare workers need to be reassured that EHR reduces their workload, takes care of mundane activities and gives them time to focus on main tasks. The benefits of EHR, such as time-saving, increased accessibility to results and data, improved data accuracy, and increased ease and speed of retrieving patient data, should be drilled into their ears.

• Demonstrating use cases and benefits with actual data from other countries and continents

Case studies from other countries with a working EHR must be shown to healthcare workers to understand the complexities of the EHR as well as the good results and improvements it has brought to their healthcare system.

• Document success stories from the pilot phase and other healthcare providers and patients

During the pilot phases, stories and experiences from healthcare providers must be captured and shared as the roll-out begins. This is a way to prove its efficiency with other physicians and healthcare officials.

• Addressing security, privacy and confidentiality concerns

Privacy and confidentiality should be held with utmost importance. The laws governing patient privacy and confidentiality must be enforced. Patient data should only be released to others on the patient’s permission. For security, records must be protected at all times. Healthcare providers must be aware of the security measures needed to protect patient data. Data can be designed to be accessible by physicians and other healthcare officials only when they are in a healthcare facility.

• Integrate a hybrid paper-digital system or provide tablets with pens on which physicians can type.

Tablets with pens can be provided to healthcare providers to help them write faster instead of typing unto the EHR. This will give them the paper to pen feel they desire, reduce typos and give them time to attend to more patients. Also, they can have the option of uploading their paper prescriptions and patient notes on the EHR.

Adopting EHR across Africa will champion the quality of healthcare delivery. Despite the barriers to adoption, considerable efforts to improve readiness will go a long way to help with a nationwide roll-out. Medtrack has positioned itself to solve this giant problem. We have iterated our platform to meet healthcare provider needs, ensuring ease of use, accessibility and overall security and sustainability. With the Ghana card owned by every Ghanaian, no patient will be left behind.