Abstract
Electronic health records are essential in the current healthcare system, especially in the context of UAE where the administration of healthcare is segmented. The research paper was aimed at examining the state of EHR adoption and use in this country. By carrying out literature research in various databases, it was established that the country has undergone significant improvements in the implementation of this Health IT service.
Introduction
The electronic health record (EHR) system is a new and better method for improving the UAE’s and the world’s health care provision (Ardito, 2014). Also known as a computerized patient record, EHRs store data about the health status of a patient, in a computer processable manner (Van Vilthoven, Mastellos, Majeed, O’Donoghue, & Car, 2016). Therefore, EHRs are an e-version of patients’ health information and a replacement of the traditional paper records that make use of information technology. Some of the important features offered by this system are telehealth functions such as teleradiology and video consultations. EHRs are more comprehensive than electronic medical records (EMR) and personal medical records (PMR). EHRs hold information on “diagnoses, medications, immunizations, family medical histories, and provider contact information” (Ardito, 2014, p. 1). All healthcare practitioners involved in a patient’s case can access these records. The EHRs also share information with other departments such as insurance, specialists, and laboratories. They can be accessed countrywide. Knowledge of how far health care units in the UAE have gone in adopting and instituting this tool, challenges in implementation and usage, and recommendations for improvement is what this paper seeks to accomplish.
Method
Research on the existing literature-databases, UAE’s Ministry of Health website, EHR provider websites, and news articles – on the state of EHR usage in the country was done. Since I researched online sources, the information was gathered from scientific databases as e.g. Ebscohost, PubMed, and Google Scholar. However, due to the similarity of medical practices globally, it was important to make reference to the literature on the scope of this technology and current inventions in health care systems internationally, and make comparative studies with the UAE.
Administration of the Healthcare System
The management of healthcare in the UAE is complex and has several authorities overseeing across different emirates and the various free zones. Healthcare units in all the emirates are self-governed. In Abu Dhabi, for instance, the Health Authority of Abu Dhabi (HAAD) is involved with regulating the healthcare industry and forming policy (Bodhani, 2016). The second authority, the Abu Dhabi Health Services Company (SEHA) manages the public hospitals in the emirate of Abu Dhabi (Bodhani, 2016). The Dubai health authority (DHA) is responsible for overseeing health care in this emirate. HAAD, SEHA, and DHA are under the Ministry of Health and prevention (MoHAP or MoH) or. Also, the Ministry of Health manages the healthcare and both private and public health units in the other emirates, including Sharjah and Ajman (Bodhani, 2016).
State of EHR adoption in the UAE
A research conducted in 2016 on the state of EHR acceptance in UAE found out that the country has a high EHR adoption rate (Van Vilthoven et al., 2016). The reason for the trend is the availability of government cooperation, support, and funding. Likewise, there is enough technical support from the EHRs infrastructure provider. Also, the research found out that the adoption rates also differed from one Emirate to another. For instance, many hospitals working under HAAD, together forming the SEHA, had an EHR system (Van Vilthoven et al., 2016). UAE’s Ministry of Health is charged with a mandate for hiring EHR s system providers. At the emirate level, institutions such as HAAD, SEHA, and DHA are the organizations given authority to supervise the adoption and use of EHRs and EMRs. For example, HAAD embraced the EMR system from Cerner (a healthcare IT company) and directed its effecting in healthcare facilities in Abu Dhabi and Al Ain in 2008 (Alawi, Dhaheri, Baloushi, Dhaheri, & Prinsloo, 2014). In 2016, the MoH “renewed and expanded its arrangement with Cerner for continued implementation of its enterprise with health IT system (Wareed project)” (Bodhani, 2016, para. 1). Cerner was to provide the Ministry with the vital technology and infrastructure, i.e., Cerner millennium® necessary to run Wareed (Bodhani, 2016). The tool serves as both EHR as well as EMR systems.
Under Wareed, each patient is given a unique number for hospital admission and access to doctors. The purpose is to ease the process of patient transfer and provide the interchange of medical data between public and individual owned hospitals and clinics. Also, it gives “the providers access to health information, including scheduling, registration, emergency, pharmacy, radiology, surgery, and other health data” (Bodhani, 2016, para. 1). The wired patient portal created an inclusive countrywide IT structure, facilitated the easy flow of health information, and promoted a uniform level of care in all public hospitals” (Cerner Corporation, 2017). The application connected all medical, functional, and administrative records into a combined system. In general, provisions by Cerner catered for 17 Healthcare units and 86 clinics, a total of 2200 beds (Bodhani, 2016). Again, Cerner and the MoH have been working together in training manpower and in implementing an anesthesia management plan for Al Baraha Hospital (Bodhani, 2016).
The Dubai Health Authority has worked on a project to make the coding of medical records uniform. This has made the medical scripting language for diagnosis, treatments, dental and giving medicines uniform, and also linked members, providers and consumers via a single electronic platform (Patel, Jamoom, Hsiao, Furukawa, & Buntin, 2013). In addition, the plan has allowed DHA to successfully observe insurance services, moderate abuse; report medical and drug dispensation errors, and follow consumer habits (Patel el al., 2013). Thus, the project has provided the emirate with a world-class health insurance industry in line with the best international practices.
In addition, among the EHR tools in operation in the UAE health facilities is the Situation, Background, Assessment, Recommendation (SBAR), a handing over tool used by nurses to eliminate the problems associated with paper handover (Cerner Corporation, 2017). This tool has helped to reduce a significant amount of time that was initially wasted inpatient hand-off. Secondly, it reduced human error associated with manual procedures and using written records for patient handover. In addition, the tool has made communication between medics easy. Likewise, nurses now have ample time to spend on patient care and not on paper handover.
Importance of EHRs
The EHR system has made it easy to document, store, and retrieve patient medical records. The system has removed the need for paper storage rooms in doctors’ offices and hospitals. The prescription has been made easy and understandable by the patient. In addition, it decreases medical mistakes, improves observation of clinical practice guidelines, and enhances the delivery of preventive health services, thus perfecting services given to patients (Bodhani, 2016). Medication mistakes are reduced since the doctor’s handwriting which cannot be read is eliminated, and the pop-up messages display on the computer warning in case a doctor has approved a wrong blend of drugs. Also, a good electronic health record system is important to the UAE as it enables “better clinical decision-making, organized management of chronic diseases (cancers, blood pressure, diabetes), and support the privatization of healthcare in this region to achieve a combined e-health environment” (Alawi et al., 2014, p. 2). Moreover, EHRs have made it easy to organize laboratory and x-ray orders and results, and the results are made available fast. The system has an excellent viewing capability, a very useful feature for patient care that permits continuity of care and to monitor the condition of chronic diseases. For instance, a physician can obtain a year’s results of blood sugar levels for a diabetic patient. Also, the EHR system has a referral and feedback system that keeps the physician informed of the patient’s state of treatment even after the patient has been transferred to another health unit (Alawi et al., 2014). The feature is important as it improves the continuity of attention given to the patient.
EHRs have made the collection of medical data easy and efficient. This data is not only useful to physicians, but also to “insurance firms, national disease centers, surveillance groups, research centers, medical associations and societies, pharmaceutical firms and marketing organizations” (Ardito, 2014, p. 1).
Concerns over EHRs
Despite the many benefits highlighted above, the EHR system presents several genuine concerns. First, there is a technical concern of similarity and inter-system operations of IT programs. For instance, at the initial stages of implementation, doctors encountered difficulties while working with EHRs due to the complexity of the system (Alawi et al., 2014). This calls for IT solution providers such as Cerner to develop and harmonize software platforms in order to eliminate the issue of software incompatibility. Secondly, hospitals and clinics are obligated to incur more expenses in improving their IT system. Financial costs encountered are in installing broadband internet, EHR system, and loans that support the maintenance and use of this system.
The other technical aspect of the EHR system involves computer system breakdowns and how to store patient information so that it is not lost in case of such problems. The system also presents the challenge of ensuring that patient information is kept confidential. There is a loss of privacy in the patient’s file for anyone access to the file can open it. Patient privacy is something to worry about especially where the information is maintained in the cloud. The lack of confidentiality of patient information is a bone of contention since it limits the benefits that a patient with chronic ailments can gain from the insurance policy providers (Van Vilthoven et al, 2016).
The other obstacles to EHRs adoption and use include the inability of hospitals to implement the technology, uneven enticements which make some hospitals bear the whole economic burden of implementing the system as the patient and the insurers benefit more (Patel el al., 2013). Acute care hospitals and rural hospitals continue to encounter hurdles in the adoption and use of Health IT, despite rapid expansion and substantial government funding. Factors limiting the implementation of EHRs in rural settings include “limited access to funds, scanty broadband internet arrangement; administrative and cultural hindrances, workflow issues and security concerns” (Alawi et al., 2014, p. 3).
Also, of concern about EHR use is whether all the physicians have sufficient computer skills to understand the EMR system. Research has established that there is “a difference in competency among UAE physicians in dealing with technology” (Alawi et al., 2014, p. 3). For example, some clinicians are slow in typing and maneuvering around the Cerner platform exchange interface. Such variations in skills and understanding of technology can undermine physician performance drastically. Thus, there is a challenge of inadequate health IT workforce.
Moreover, EMR adoption and usage lag behind in some health care facilities due to opposition by physicians, lack of cooperation by the leaders and the healthcare management, and the legal issues surrounding the use of EMR.
There is some reluctance in accepting to use EHRs by the doctors due to concerns of minimal eye contact between them and their patients, and also because patients have to wait for long before being attended to as a lot of time is used in data entry. The system consumes a lot of the physician’s time and demands elaborate documentation. Despite this, health practitioners have adjusted and patients have come to appreciate the system as a reflection of technological improvement (Patel el al., 2013). Determining the extent to which patient health information should be used for secondary purposes is a legal and ethical issue surrounding EHRs. In addition, it is very hard to obtain approvals to use the data from more than one institution.
Recommendations
Since EHRs are good in improving patient care and efficiency in simplifying the physician work and yet they have some inherent shortcomings, a suggestion to improve the system is not a misguided opinion. First of all, physicians ought to be allowed more time to deal with patients. That means that the amount of documentation fed by the doctors in the system during a consultation should be reduced. In addition, the computerized documentation design should be made simpler to use by the physicians and the patients (Alawi et al., 2014). To solve the challenge of inadequate health IT staff, there is a need to put in place an extensive EHR training program for staff in the medical field.
Further, a better connection between the EHR system and the records from HAAD, SEHA, and DHA should be established. The link between Cerner and these authorities will help the physicians in writing sick leave notes and notification of disease. The system should be upgraded in order to promote the confidentiality of patient health information.
Conclusion
In general, the state of incorporation and use of the EHR system in the UAE is at an advanced level. It is comparable to that of countries like Saudi Arabia and Taiwan. The Ministry of Health has availed itself to ensure that the healthcare stakeholders get all the financial, technological, and legal support they require. Hospitals and clinics have been equipped with these IT services. The MoH has continued to work with Cerner and other healthcare IT service providers. That means that there are even greater plans to strengthen the healthcare facilities’ telehealth, and health data exchange capacity soon. As a result, the myriads of challenges that had surrounded this process at its initial stages will reduce considerably.
References
Alawi, S. A., Dhaheri, A. A., Baloushi, D. A., Dhaheri, M. A., & Prinsloo, E. A. M. (2014). Physician user satisfaction with an electronic medical records system in primary healthcare centres in Al Ain: a qualitative study. BMJ Open, 4(1), 1- 8. Web.
Ardito, S. C. (2014). Electronic Health Records: How the conversion of print media records could transform the healthcare industry. Web.
Bodhani, A. (2016). MOHAP expands electronic health records project with Cerner. Web.
Cerner Corporation. (2017). United Arab Emirates Ministry of Health facilitates communication of patient information among caregivers: Saves time and reduces errors. Web.
Patel, V., Jamoom, E., Hsiao, C., Furukawa, M. F., & Buntin, M. (2013). Variation in electronic health record adoption and readiness for meaningful use: 2008– 2011. Journal of General Internal Medicine, 28(7), 957–964. Web.
Van Vilthoven, M. H., Mastellos, N., Majeed, A., O’Donoghue, J., & Car, J. (2016). Feasibility of extracting data from electronic medical records for research: an international comparative study. BMC Medical Informatics and Decision Making, 16(90), I -10. Web.
