The Roundup

Electronic Health Records: Promises and Realities: A 3-Part Series Part I: The Digital Sea Change, Ready or Not

To explore the influence of varying degrees of remoteness on practice-level electronic medical record (EMR) adoption, including whether the effect differs across practice specialty. Survey data on over 270,000 office-based physician practices (representing over 1,250,000 providers) collected by SK&A information services during 2012. This study examined differences in EMR adoption by practices located across the nine-category rural-urban continuum. Logistic regressions and associated marginal effects are used to assess how much a move up or down the rural-urban continuum code impacts the likelihood of EMR adoption, after controlling for characteristics likely to affect EMR adoption such as practice size and specialty. Overall practice-level EMR adoption rates generally increase with the degree of rurality and range from 47 percent in the most urban counties to over 60 percent in the most rural. Moving from the most urban county to the most rural corresponded to a 7 percent increase in the likelihood of EMR adoption (p<.01). EMR adoption rates do vary significantly across nonmetropolitan counties, and they generally increase as a practice becomes more rural. From a policy perspective, this suggests that urban practices may in fact be the lowest hanging remaining fruit for increasing EMR adoption rates.

Everybody On Board Stage 3 Meaningful Use in 2018

The focus on healthcare information technology (IT) has led to remarkable growth in healthcare IT staffing.The federal government is moving ahead with its plan to advance the use of electronic health records (EHRs) in the U.S. healthcare system. The Centers for Medicare &amp; Medicaid Services (CMS) recently collected public comments related to its proposed rule for Stage 2 of the “meaningful use” program. Under the three-stage program, hospitals and other healthcare facilities that demonstrate a meaningful use of EHRs are eligible for Medicare and Medicaid incentive payments.1 Stage 2 builds on Stage 1, laying out the requirements for healthcare providers.The push for EHRs got a huge boost with the American Recovery and Reinvestment Act of 2009, which committed billions of dollars to support the adoption and use of EHRs, building on an earlier goal that every American should have an electronic medical record by 2014. Fundamentally, EHRs are digital documentation that includes data from a visit to the doctor's office or office, including the patient's histories, exam notes, tests ordered and their results, drugs prescribed, and any other results or updated information. Some systems also check for drug interactions, can access X-rays, and even deliver a reminder for the patient to get a flu shot.2In certain quarters, hopes are high about the benefits of EHRs. Some talk of millions of dollars and thousands of hospitalizations saved—seemingly based on extrapolated data. Generally, there is the anticipation, especially by the government, that the use of EHRs will improve the quality, safety, and efficiency of healthcare delivery, as well as reduce medical errors, healthcare costs, and paperwork.On the other side of the coin, there are several who warn that it's premature to start talking about the benefits of EHRs, saying the transition will not be easy or fast. Take, for example, the benefits expected from data sharing. Peter Gabriel, director of informatics with the Department of Radiation Oncology at the University of Pennsylvania's School of Medicine, said that it could be 10 or 15 years before data sharing in health IT is widespread, because it's “a lot harder to achieve than most people appreciate. Simply implementing computer systems won't dramatically improve quality overnight.”3Obviously, health IT growth must also be tempered with risk assessment every step of the way. The development of 80001-1, the standard that deals with the application of risk management for IT networks that incorporate medical devices, indicates that risk analysis is getting woven into many health IT growth game plans. This kind of due diligence will likely stretch original timelines as they relate to the use of EHRs.CMS seems to be sensing that it will take a lot longer than initially anticipated as well. Its recent announcement, a notice of proposed rulemaking (NPRM), attempts to strike a balance between sustaining forward momentum toward meaningful use goals and ensuring that providers with greater obstacles to EHR adoption have the time, support, and incentive to catch up.4A survey published late last year by the Centers for Disease Control indicated that there is a wide variation among states in EHR adoption rates, ranging from a low of 40 percent to as much as 84 percent. As those numbers grow, so will healthcare IT staffing needs. According to the Bureau of Labor Statistics, the projected job growth rate for information security analysts, web developers, and computer network architects is 22% between 2010 and 2020. That's well above the average growth rate of 14% for all occupations during that same period. In its projection, found in the latest edition of the Occupational Outlook Handbook, the bureau makes note of the changes in healthcare and of their impact on this significant job growth.5“As the healthcare industry expands its use of electronic medical records, ensuring patients' privacy and protecting personal data are becoming more important,” the handbook reads. “More information security analysts are likely to be needed to create the safeguards that will satisfy patients' concerns. Demand for computer network architects will increase as firms continue to expand their use of wireless and mobile networks. This occupation will be needed to design and build these new networks, as well as upgrade existing ones. In addition, the expansion of healthcare information technology will cause an increase in the use of networking technology in that industry, and more computer network architects will be employed there.”The bureau makes a similar point in its projection of a 28% growth rate for jobs for network and computer systems administrators, again emphasizing the role of healthcare in fueling the demand.“Growth is expected in healthcare industries as their use of information technology increases,” says the handbook. “More administrators will be required to manage the growing systems and networks found at hospitals and other healthcare institutions.”To help meet the expected demand for health IT workers, the Obama administration launched training programs for such workers. Funded under the auspices of the Office of the National Coordinator for Health Information Technology (ONC), this training is offered through 82 community colleges and nine universities across the country. As of January 2012, the administration says that community colleges have trained more than 9,000 students for health IT jobs, with nearly as many currently enrolled. For the participating universities, more than 1,200 have enrolled and almost 600 have already graduated as post-graduate and masters-level IT professionals. And there is an expected increase to about three times as many by the summer of 2013.There are other support mechanisms in place as well, such as the Health IT Workforce Curriculum from the ONC, which provides teaching materials at no cost to instructors. Yet another is the HIT Pro Exam, also from the ONC, with more than 2,000 examinees since its launch in May 2011. The exam shows perspective employers that the job candidate has the knowledge and skills required to work in health IT. If you've ever seriously considered moving to healthcare IT, there may not be a better opportunity.For some, the only incentive in participating in the meaningful use program may well be the immediate financial reward rather than the long-term gains. There are experts who say that the EHR program, as it currently stands, means more work and less efficiency. For example, the EHR collects data on a patient's smoking status which requires the provider to fill out another form to track smoking status for the meaningful use program. As Farzad Mostashari, MD, the national health IT coordinator said, “No wonder providers are saying that meaningful use is adding work and not making sense to them. We have a lot of learning to make meaningful use of meaningful use.”5To date, more the $3 billion has been paid out to some 2,000 hospitals and 41,000 physicians. In January 2012 alone, $519 million was paid to eligible providers with up to $44,000 each under the Medicare EHR Incentive Program and $64,000 each under the Medicaid program.3The transition to EHRs is expected to extend well into the next decade. The incentives for building a meaningful EHR system eventually turn into penalties for not complying under the federal program. Since Medicare and Medicaid reimbursements can mean more than 50% of a hospital's revenue, eligible providers have a significant financial interest in demonstrating meaningful use of EHRs.For healthcare technology management professionals, the time is ripe to learn new skills and take advantage of new job opportunities. We're already seeing health IT adopt more mainstream computing and networking initiatives and technologies such as virtualization and software defined networks. These kinds of technologies also generate risk analysis— another form of health IT growth requiring staffing. Once in place, newer technologies will relieve IT techs and engineers from some of the mundane network administrative duties. Automated network and software management protocols will also help keep track with and compliance to an ongoing and dynamic risk analysis.All of this adds up to a safer system, while improving the quality and efficiency of healthcare delivery. Healthcare IT organizations are going to need the staffing to keep pace with providing the newer technology to healthcare's advantage.

The adoption of electronic medical records (EMRs) in the Philippines has been initiated and adjusted since the last decade through the Philippine eHealth Agenda framework. EMRs are known to improve clinical management and have been widely adopted in advanced economies. However, empirical research on EMR implementation remains limited. This study aims to determine how public primary health care facilities in the country interacted with EMRs before and during the COVID-19 pandemic to understand EMR adoption. More than 270,000 records generated from EMR usage logs in six rural primary health facilities in Western Visayas were analyzed. Average time of EMR use during work hours was estimated and compared before and during the pandemic. EMR adoption based on specific EMR features used was also determined. In 2020, EMR use ranged from less than one hour to more than eight hours in selected rural health units (RHUs). There was a statistical increase and decrease in use of features during the pandemic. Some EMR users had efficient use indicated by complete adoption of EMR features although such features were not as frequently used as those pertaining to basic adoption. This study demonstrates that for EMR use in rural settings, progressive use from basic to complete may vary among users. Public health emergencies such as a pandemic may also affect EMR use. Future research directions should explore other mechanisms which affect user behavior and encourage full adoption of technology such as use of games or non-monetary incentives.

Purpose The purpose of this paper is to investigate the elements that health care personnel in Thailand believe are necessary for successful adoption of electronic medical record (EMR) systems. Design/methodology/approach Initial qualitative in-depth interviews with physicians to adapt key elements from the literature to the Thai context. The 12 elements identified included things related to managing the implementation and to IT expertise. The nationwide survey was supported by the Ministry of Public Health and returned 1,069 usable questionnaires (response rate 42 percent) from a range of medical personnel. Findings The key elements clearly separated into a managerial dimension and an IT dimension. All were considered fairly important, but managerial expertise was more critical. In particular, there should be clear EMR project goals and scope, adequate budget allocation, clinical staff must be involved in implementation, and the IT should facilitate good electronic communication. Research limitations/implications Thailand is representative of middle-income developing countries, but there is no guarantee findings can be generalized. National policies differ, as do economic structures of health care industries. The focus is on management at the organizational level, but future research must also examine macro-level issues, as well as gain more depth into thinking of individual health care personnel. Practical implications Technical issues of EMR implementation are certainly important. However, it is clear actual adoption and use of the system also depends very heavily on managerial issues. Originality/value Most research on EMR implementation has been in developed countries, and has often focussed more on technical issues rather than examining managerial issues closely. Health IT is also critical in developing economies, and management of health IT implementation must be well understood.

Electronic Health Records: Can Promise Be Fulfilled?

The qualification of CE, incorporating both engineering and medicine, was first established in 1987. The CE is a health care professional who ensures the safety and effectiveness of medical equipment. A basic duties guideline for CEs was devised in 2010. The main duties of the CE are classified as respiratory therapy, cardiopulmonary bypass , dialysis units, intensive care units, cardiac catheterization, hyperbaric oxygen therapy, pacemakers and medical equipment management. To enhance the ability of CEs to engage in more extensive duties and develop specialties, there is a certification system in each field. The CE plays a role that is socially important by ensuring the safety of medical equipment and its effective maintenance. Purpose of establishment of CE Recent progress with medical equipment has extended the range of medical care, and specialists who can operate and maintain many complex pieces of equipment are required. The qualification of CE, incorporating both engineering and medicine, was first established in 1987, and CEs began to work in Japan from 1988. The CE is a health care professional who ensures the safety and effectiveness of medical equipment. Current state of CE education A CE must graduate from a CE training school (university, junior college, or technical school) and pass a national examination. The training schools devised guidelines for the national examination to maintain a certain standard of CE education. The examination covers questions from the fields of medicine, engineering, and medical technology. The number of questions is 180 (90 in the morning and 90 in the afternoon) and the examination is carried out over 2 sessions of 2.5 hours each. There are some universities setting up graduate schools for CE education, and there are some CEs who already have a master’s degree or a doctorate in the field of BME. Present status of CEs As of 2012, there are approximately 12,000 CEs in Japan. A basic duties guideline for CEs was devised in 2010[1]. The main duties of the CE are classified as respiratory therapy, maintenance of cardiopulmonary bypass units, dialysis equipment, and surgical equipment, intensive care Koichi Umimoto Department of Biomedical Engineering Osaka Electro-Communication University, Osaka, Japan (Tel: 072-876-5376, Fax: 072-876-5281 e-mail: umimoto@isc.osakac.ac.jp). units, cardiac catheterization, hyperbaric oxygen therapy, other treatment (defibrillators, pacemakers, and implantable cardioverter defibrillators) and medical equipment management. A team of CEs are involved in dialysis. The duties of CEs in the dialysis unit are preparation of the dialysis sets, blood access, operation of the equipment and monitoring patient during treatment, and maintenance of the dialysis equipment. Certification for CEs in each field To enhance the ability of CEs to engage in more extensive duties and develop specialties, as well as provide better health care services, there is a certification system in each field. This involves certification by the Japanese CE Society and the Associated Societies. Regarding certification by the Japanese CE Society, there is a CE certification system for specialization in blood purification, a pacemaker-related CE specialty, and a respiratory treatment specialty. Regarding certification by the Associated Societies, there are qualifications in dialysis technology, extracorporeal circulation technology, respiratory therapy, clinical medical engineering equipment technologist, hyperbaric oxygen therapy, and apheresis treatment. Future prospects Since the CE was born in 1988, 24 years have passed. The CE plays a role that is socially important by ensuring the safety of medical equipment and its effective maintenance. In addition to technology, we must develop managerial skills for medical equipment like CEs in the USA. Therefore it is important to establish an advanced CE education system in Japan like that of the American College of Clinical Engineering[2].

Hospitals and other health settings across Canada are transitioning from paper or legacy information systems to Electronic Medical Records (EMR) systems to improve patient care and service delivery. The literature speaks to benefits of EMR systems, but also challenges, such as adverse patient events and provider workflow interruptions. Theoretical models have been proposed to help understand the complex interaction between health information technologies and the healthcare environment, but a shortcoming is the transition from conceptual models to actual clinical settings. The health ecosystem is filled with human diversity and organizational culture considerations that cannot be separated from technical implementation strategies. This paper analyzes literature on EMR implementation and adoption to develop a tactical framework for EMR adoption. The framework consists of six categories, each with a set of seed questions to consider when leading technology adoption projects.

To examine physician characteristics and practice patterns associated with the adoption of electronic medical records (EMRs) in smaller group practices. Primary care physicians in Kentucky were surveyed regarding their use of EMRs. Respondents were asked if their practice had fully implemented, partially implemented, or not implemented EMRs. Of the 482 physicians surveyed, the rate of EMR adoption was 28%, with 14% full implementation and 14% partial implementation. Younger physicians were significantly more likely to use EMRs (p = 0.00). For those in their thirties, 45% had fully or partially implemented EMRs compared with 15% of physicians aged 60 and above. In logistic regression analyses that controlled for practice characteristics, age, male gender, and rural location predicted EMR adoption. Younger physicians in smaller group practices are more likely to adopt EMRs than older physicians. EMRs were also associated with an increased use of chronic disease management.

Background Electronic Medical Records (EMRs) have emerged as vital tools for enhancing the quality and coordination of healthcare services worldwide. By providing convenient access to patient history, reducing medical errors, and streamlining workflow, these digital systems can significantly improve overall patient outcomes. However, in many developing countries—including Somalia—adoption of EMRs remains slow and inconsistent. Specifically, public health facilities in regions like Banaadir continue to face structural, technical, and organizational barriers that inhibit the rapid and widespread utilization of these technologies. Objectives The broad objective of this study was to assess the level of adoption of EMRs among health workers in selected public health facilities in Banaadir. The specific objectives of the study were: To determine the socio-demographic characteristics, technological factors and health system factors associated with adoption of EMRs. Methodology A descriptive cross-sectional research design was adopted to provide a snapshot of EMR use in selected Banaadir public hospitals. The study population comprised doctors, nurses, laboratory technicians, and administrative staff who regularly handle patient records. A sample of 150 respondents was drawn using stratified random sampling to ensure representation from each professional cadre. Quantitative data was collected through structured questionnaires. Descriptive statistics were used to determine frequencies, means, and standard deviations. As for inferential statistics, χ2 test was used to determine the association between independent variables and EMR adoption. Key Findings The study achieved a high response rate of 88.9% (n=80). EMR adoption was significantly influenced by age (p=0.001; Cramer’s V=0.284), with younger health professionals more likely to adopt the systems. Educational level also played a crucial role (p=0.001; Cramer’s V=0.292), as those with higher academic qualifications exhibited higher usage. Furthermore, the frequency of software usage showed a strong positive correlation with adoption (p=0.001; Cramer’s V=0.284), demonstrating that routine interaction with digital systems promotes familiarity and integration into clinical workflows. Regarding institutional factors, the extent of EMR implementation within hospitals significantly impacted adoption (p=0.013; Cramer’s V=0.328). Facilities with complete or partial EMR systems reported higher staff uptake compared to those without implementation. Notably, 61.3% of respondents indicated that their hospitals operated under a hybrid model combining paper-based and electronic systems, signalling ongoing digital transition. Most respondents (82.5%) reported basic computer literacy, while 81.3% had previous exposure to EMR systems. However, technological barriers persist. Limited availability of EMR software (Mean=2.44, SD=1.20), concerns over data privacy and internet connectivity (Mean=2.57, SD=1.18), and inconsistent technical support were highlighted as major impediments. Despite these challenges, a majority expressed positive perceptions of EMRs, particularly in enhancing data management and patient care. Conclusion This study highlights a critical disconnect between the recognized benefits of EMRs and their actual implementation in routine healthcare practice within Banaadir’s public hospitals. While health workers acknowledge the value of digitized records, widespread adoption is constrained by systemic issues such as limited ICT infrastructure, insufficient technical support, and individual challenges like digital illiteracy and resistance to change. As a result, the full potential of EMRs to improve patient care, streamline clinical workflows, and support data-driven decisions remains largely untapped. Addressing these challenges will require coordinated, multi-level strategies—strengthening infrastructure, investing in capacity-building, and cultivating a policy environment that actively supports digital transformation. Without these efforts, EMRs will continue to fall short of delivering their intended impact on Somalia’s healthcare system. Recommendations To improve EMR adoption in Banaadir’s public health facilities, key actions are needed. First, provide regular digital literacy training tailored to different professional and age groups to build user confidence and competence. Second, invest in reliable ICT infrastructure, including stable internet, hardware, and on-site technical support. Full implementation of EMR systems in all hospitals should be prioritized, as partial or no implementation limits adoption. Additionally, policies that promote digital acceptance and accountability should be introduced. Collaboration between government, health institutions, and partners is essential to create a supportive environment for sustained EMR integration.

IntroductionThe ability to utilize the electronic health record (EHR) without compromising the doctor-patient relationship (DPR) is an essential skill of all physicians and trainees, yet little time is spent on educating or assessing learners on needed techniques. To address this gap, we developed a conventional OSCE station coupled with a simulated patient chart within the Epic program in order to assess our students' skills utilizing the EHR during a patient encounter.MethodsOf third-year medical students, 119 were given full access to the patient's simulated chart 24 hours in advance of their OSCE to review clinical data. During an in-person OSCE with a standardized patient (SP), students performed a focused history and physical, using the EHR to verify allergies and medications. Students completed an electronic patient note graded by faculty. SPs evaluated the students on communication and interpersonal skills with specific rubric elements. Faculty graded the students' notes to evaluate their expression of clinical reasoning in the assessment and plan.ResultsTraining SPs and faculty to assess students on EHR skills was feasible. After implementation of a comprehensive curriculum focused on EHR and DPR, there was a significant difference on EHR-related communication skills (M = 76.4, SD = 17.6) versus (M = 37, SD = 28.9) before curriculum enhancement t (117.9) = −12.4, p <.001.DiscussionThe EHR OSCE station provided a standardized method of assessing students' EHR skills during a patient encounter. Challenges still exist in the technological requirements to develop and deliver cases in today's EHR platform.

Adopting electronic medical records (EMR) in type C hospitals is essential for improving patient quality and safety. However, resistance within the healthcare industry and reluctance to accept new technologies present significant barriers. This delay in EMR implementation affects the quality of patient care and public health. This research aims to analyze the organizational factors that influence the adoption of Electronic Medical Records (EMR). There are six independent variables related to the organization, namely Management Support, Adequate Training, Patient Safety Climate, Physician’s Involvement, Physician’s Autonomy, and Patient Relationship. These variables are related to two mediating variables from the Technological Acceptance Model (TAM) theory, Perceived Usefulness and Perceived Ease of Use, which directly influence EMR adoption, moderating by Openness to Experience. The method used in this research was a survey of medical health workers whose work was related to EMR. Cross-sectional data were taken from 205 respondents from two type C private hospitals in December 2023. The data analysis method used was Partial Least Squares-Structural Equation Modeling (PLS-SEM). The research findings show sufficient evidence to state that all independent variables have a significant and positive influence on Perceived Usefulness and Perceived Ease of Use (P-value &lt;0.05, CI 95%). The strongest influence was found in Patient Relationship (β=0.501) and Patient Safety Climate (β=0.404). The results of this research can provide suggestions for improving patient conditions and illnesses, thereby enhancing the quality of care and benefiting the overall health of communities through the implementation of EMR.

Toward a More Complete Picture of Outpatient, Office-Based Health Care in the U.S.

Introducing new technology, such as an electronic medical record (EMR) into an Intensive Care Unit (ICU), can contribute to nurses' stress and negative consequences for patient safety. The aim of this study was to explore ICU nurses' perceptions of factors expected to influence their adoption of an EMR in their workplace. The objectives were to: 1) measure psychological factors expected to influence ICU nurses' adoption of EMR, and 2) explore perceptions of facilitators and barriers to the implementation of an EMR in their workplace. Using an explanatory sequential mixed method approach, data were collected using surveys and focus groups. ICU nurses reported high scores for motivation, work engagement and wellbeing. Focus group analyses revealed two themes: Hope the EMR will bring a new world and Fear of unintended consequences. Recommendations relate to strategies for education and training, environmental restructuring and enablement. Overall, ICU nurses were optimistic about EMR implementation.