One can posit that the aim of the

One can posit that the aim of the dual system was to allow for a transition rivastigmine tartrate whereby clinicians could continue to use paper records for documentation, which were scanned to the online database to be available for effective communication while these same clinicians slowly familiarise themselves with a full EMR system. The dual system, however, does not seem to be working at KH. In a resource-limited area, fixing this problem will involve short-term and long-term changes. In the short term, the goal is to figure out ways to optimise the ECM online database. This should involve increasing resources, manpower, supervision, and training. One example of a change in resources concerns the lack of vital signs in patient charts. It could be that temperature and blood pressure measurements are left out of patient charts because thermometers and blood pressure cuffs are scarce in the hospital. These vital signs, however, cannot be overlooked, as they are used to calculate patient severity scores, which have been shown to be sensitive and specific predictors of patient outcomes. It could also be that the healthcare workers do not know how to use these instruments. Or, it could be that the healthcare workers do not record these values because there is no accountability for not doing their jobs. All of these are possible reasons for incompletely filled out folders, and any hospital looking to use systems like this should first address these issues. Another example of lacking resources can be seen in the medical records department, where there are workers and adequate supervision, yet there are only a few scanners available in a hospital that serves the needs of the 400,000 residents of Khayelitsha. Meeting such demands is quite a difficult task to achieve, as evidenced by the stacks of folders waiting to be scanned in the records office. Although improvements in these areas require upfront costs, they are necessary to achieve the full advantages of the ECM online database.
In the long term, a complete conversion to a full EMR system that involves direct input of doctors’ and nurses’ notes into the computer will be the most ideal solution. Such a system should apply the “cradle to the grave” approach. For an efficient EMR system to be implemented, there must be important pieces in the toolkit, including the development of a system that has adaptable, interoperable, and scalable software while fostering relationships in the community to provide “technical, financial, and training support”. Since the Western Cape market is dominated by Clinicom, this would be the most likely system to be implemented. As expected, this is a larger undertaking, and requires a large investment to implement and maintain. Some solutions are available to help with funding. Governments like the US have provided incentives for “meaningful use” of this technology to healthcare facilities. The South African government can do the same, providing subsidies for hospitals that use the system and penalties for those that do not. Furthermore, there are cheaper and more malleable options for EMRs, such as open source versions, which would be much more feasible in a low-resource environment.
For any new technology, there is always a lag time for adjustment. This is another one of the pitfalls for the EMRs. The time can vary according to institution, with some institutions taking up to two years of dedicated effort to achieve full use. It could be that KH needs a few years for all the systems to come into place and fully realise the benefits of the installed records system. Further research should look at how efficient the system is in the coming years. Additionally, this study had only a small sample. Though KH is a large and fairly representative hospital of those in South Africa installing EMRs, this study only looked at the effects on one department in one large hospital. Future studies should look at more hospitals to determine whether there are common issues and solutions. Finally, as both the registry and Clinicom were incomplete, it was difficult to establish a gold standard for the trauma load at KH. It is possible that some of the encounters on Clinicom were incorrectly coded as non-trauma, thereby underestimating the trauma load.