IMPACT OF ELECTRONIC HEALTH RECORDS IN SRI LANKA: CASE STUDY OF GOVERNMENT HOSPITALS.

SHRIyananda RathnayakeProgramme Manager – ICT Agency of Sri Lanka

Background

• High life expectancy of 77.4• Low rate of maternal mortality (41.6 per 100,000 live

births)• Low rate of infant mortality (8.5 per 1,000 live births)• Over 89% of the population has access to safe drinking

water • 85% of population has proper sanitation facilities

BUT The burden of Non Communicable Diseases (NCD) have

increased rapidly during last two decades Communicable diseases such as Tuberculosis, Leprosy,

Dengue is on the rise due to environmental and social factors

Why EHR • Total health expenditure in Sri Lanka is recorded as

between 3.4% and 3.7% of GDP • Contribution from government to health care

expenditure 47%.

• Contribution from Private sector 53% 80% of out-of-pocket expenditure 20% of Insurance, non profit activity contribution

Private sector is expanding further, outpatient care and medical laboratory services

Patients accessing healthcare services in an ad hoc and piecemeal fashion owing to cost of care

NCDs are chronic in nature and demand systematic treatment protocols being adopted in disease management.

Poor management of such diseases leads to worsening health condition

Government Health -OPD settings • Long Queue• Maximum 2 minutes per patient• No time to ask patient history • No health information, • Long stay to access the health care

Why EHR

2010 2011 2012 2013 2014 2015 2016 2017

EHR implementation

kick off. HHIMS v.1.0

Dr. A.I JagodaDr. K.N.G

SenevirathneLunar Technology

Karawanella B.HHHIMS v 1.1

Dompe D.HHHIMS v 1.2

(Beta)Queue

management system

Dr. Sampath Kulathilake

HHIMS v 1.3 Release

Stable Version

Dr. Sampath Kulathilake

Dr. Yasith Mayabandara

HHIMS v 1.4 Awissawella

Base Hospital

Dr. Pradeep KeerthiMallawa

Dr. Shantha Senevirathne

Dr. Sampath Kulathilake

Nipun Sachindra

HHIMS v 2.0 Base hospital

Panadura (2014)

HHIMS v 2.0 and HHIMS v

2.1

(will be release soon)

HHIMS v 3.0(Cloud Based)Android App and mobile devices for Ward RoundNational DB for Patient

Registration (Central PHN Registration)

Dr. Clive James

Dr. Sampath Kulathilake

Dr. Yasith Mayabandara

Dr. A.I Jagoda

History and Versions

What is HHIMSHHIMS is Free and Open Source Hospital Health Information Management System specially designed for the requirement of Sri Lankan hospitals. HHIMS comprises Electronic Medical Record (EMR), Computerized Provider Order Entry (CPOE), Pharmacy Management, and Laboratory Information Management.

Research Settings • Research Question - To what extend adaptation of electronic

health records improve the quality and efficiency in government health care services

• Research Sample - Dambadeniya, Mahaoya, Awissawella Base hospitals and Dompe District Hospital.

• Survey Method – Mixed Method, (Qualitative and Quantitative Method)

• Data Collection Techniques - Questionnaire, Focus Group Discussions (FGDs) and Key Informant Interviews (KIIs). Telephone interviews

• Respondents - Medical staff and health care services staff at hospitals, Patients and individual beneficiaries.

Research Focused

• Level of awareness of information system • Level of usage of information system • Whether or not users believe that there are benefits from

HIS• Whether the users are aware of the benefits of HIS• Whether the users believe that the HIS is sustainable• Critical success factors according to the users views • Negative impacts if any form due to HIS• Usability and operational difficulties• Awareness on Organizational benefits and challenges in

use of HHIMS

Results

81%

3%

59%

22%

35%

19% Hassel free quality and speedy health service

Can make advance appointments now

No need to repeat our details

Accurate diagnosis

Enhanced care by the doctors

Appropriate management plan for the patients

Results 93% of the patients have mentioned that they think it is

beneficial for them to get services from hospital which has a HIS.

Among them 79% experienced reduction of waiting time for health care services

59% believes that HIS enhanced quality of health service since the records will be reviewed by other doctors in a future day when the same patient visits the hospital

93% of the patients believe that there are no negative impacts and only 7% have said there are negative impacts due to the failures of the system.

Usability and operational acceptance play a major role in implementing the HIS in any health care institute

88% of system user rate the HIS as “easy and user-friendly” 99% of the system users are familiar with the system.

94% of system users believe that they are benefited through HIS implementation

70% of health care staff believes that the HIS implementation resulted reduction of patient waiting time

52% mentioned that it is also pave the path for hassle free healthcare services.

More than 50% of health staff mentioned that availability of electronic medical records create an environment to improve the quality of care by health staff.

Results

Limitations of research

The medical staff, nurses and pharmacists at the dispensaries were extremely busy throughout the day

Three hospitals have implemented the HIS (HHIMS) only in OPD and clinics sections and only Dompe district hospital implemented the system covering inward section

system implementation in clinic section also limited to few clinics such as family medical clinics.

Photo Story

Needs a bit of a computer literacy. Need a bit of English Knowledge (esp. Registration

Desk staff ). Need the supervision of a IT admin Power failure solution is needed. Difficult to use in extreme weather(thundering)

Drawbacks

• Health Information system implementation in government hospitals will lead to quality and efficiency improvement of the health sector in Sri Lanka.

• More empirical research to be conducted to measure the outcome and impact

Conclusion

Q & A