Electronic medical and health record systems for small island developing states: Review
BACKGROUND
As a component of digital health systems, electronic medical and health records (EMRs/EHRs) play a fundamental role in patient management and effective medical care services. An EHR is an electronic system used and maintained by healthcare systems to collect and store patients’ medical information. EHRs are used across clinical care and healthcare administration to capture a variety of medical information from individual patients over time, as well as to manage clinical workflows. EHRs contain different types of patient-level variables, such as demographics, diagnoses, problem lists, medications, vital signs and laboratory data. Many EMR/ EHR share multiple core functionalities, including the capture of health information, orders and results management, clinical decision support, health information exchange, electronic communication, patient support, administrative processes, and population health reporting. EHRs also provide a unique opportunity for health systems to develop their own internal registries or to contribute to external registries outside of health. EHRs also allow access to patient records from national health facilities across the country.
The Pacific countries are progressing from paper-based records to electronic records. A landscape review of electronic health information systems conducted in 2017 - 2018 found that distinct EMR/ EHR solutions were the common digital health tool adopted in the Pacific region. Different countries are also at different stages of readiness and maturity with their adoption. As the adoption continues to increase rapidly, dissatisfaction of these systems also continues to increase. This is driven primarily by usability and patient safety challenges, including total cost of ownership concerns such as ongoing costs and maintenance issues.
The development of EMR/ EHR systems are still high-risk and perpetuated with uncertainty. EHRs continue to be a challenging task calling for localized needs and ensuring availability of adequate technologies and resources. Shared experience with creating EMR/EHR systems for the developing world are much scarcer. The requirements, priorities and local constraints are less well understood and possibly more heterogeneous than anticipated. It is possible that requirements in the Pacific can be dramatically different from those in other regions. Adoption of EHRs in the Pacific constrained with the lack of foundational infrastructure, untrained staff, and ill-equipped health care providers has been well documented and have been a perpetual problem in the region. One of the main barriers to adopting EMR/ EHRs in low- and middle-income countries is the total cost of ownership (i.e. TCO), namely the acquisition and implementation costs, the ongoing maintenance and technical support, and the continuous training for sustainable adoption. Health and medical record solutions are usually the most expensive single investment in these countries. As healthcare facilities in low- and middle-income countries adopt digital health systems to improve hospital administration and patient care, it is important to understand the adoption process and further assess the implementation feasibility and sustainability of EMR/ EHRs in small developing islands.
PURPOSE/SPECIFIC OBJECTIVE OF THE ACTIVITY
The ultimate outcome is to narrow the choices of EMR/ EHR solutions for countries. The analysis will provide information on selected systems for each setting, the pros and cons, and the expected maintenance requirements and investments including the ongoing costs, etc. It will also provide a checklist of minimum mandatories of EMR/ EHR functionality and normalized to the Pacific context. The Study will also provide technical considerations such as, “If you want an open source EHR, you must have these …”. The expected outcome of the Study is to:
- • Simplify and reduce decision-making cycle.
- • Reduce the number of solutions to select from with justifications and cost considerations attached (i.e. reduce the options).
- • Minimize the cost of selecting a solution.
- • Increase funding allocated to developing a digital health strategy.
- • Increase funding to institute good practices (i.e. including change management, human-centred methodologies, etc.) and sustainability.
- • Increase adoption rate and usability.
- • Support PHIN’s advocacy of shared innovation/ shared services under its regional collaboration agenda 2019-2021.
- • Provide a guideline and template for developing an EMR/ EHR high level investment concept note.
- • The expected outputs of the study are:
- An inception report, and
- Regional report that includes an assessment of the value quotient of adopting EMR/ EHR solutions relative to the country's adoption, utility and capabilities.
- • Regional presentation through webinar or in the PHIN meeting
DESCRIPTION OF ACTIVITIES TO BE CARRIED OUT
- • Update the 2017 review of the EMR/ EHR systems currently in use in the Pacific (there are several countries in developing and planning to upgrade/change their current software solution) jointly with the Pacific Health Information Network (PHIN) to understand the current adoption and use in the region. Output as excel format. The analysis of existing system should cover some aspects how readiness assessment adoption was done in the countries (questionnaire/key informant interviews)
- • Develop the study’s methodology, framework and design and required data sources, workplan, timelines as part of inception report etc.
- • Develop the minimum high-level requirements of an EMR/ EHR system that should fulfil to serve (i.e. to capture a variety of medical information from individual patients over time, as well as to manage clinical workflows) and conduct a global market scan of EMR/HER solutions that would meet these needs. Note that countries vary with digital health maturity, size and requirements. The analysis should take account also usability and system architecture and interface. Assess whether systems have been tested with user-centred design (UCD) process and if there are valid information of their user-friendliness.
- • With the market scan, assess the shortlisted EMR/ EHR systems’ capabilities and implementation feasibility, cost and sustainability, pros and cons in small developing islands (e.g. commercial/ public opensource vs. proprietary systems)
- • List of other software and standards required. Assess capabilities of solutions for integrating required systems and standards (such as laboratory and imaging solutions, clinical minimum data sets, ICD10, etc.) provide high-level estimated cost if they are not integrated into the system package.
- • Assess software capability/ feasibility for public health to link third party software such as registries and surveillance with existing EHR platforms (e.g. integration of registries, integration of coding tools such as IRIS, and ICD11, integration of surveillance and outbreak response management tools).
- • Conduct key informant interviews with vendors to explore their views on sustainability and service and technical assistance provision to small island countries.
- • Develop a Guiding Principles for Selecting and Using Technologies checklist to guide the countries in adopting the software. The guideline will encompass a range that include business and technical requirements, software selection, maintenance plans, adoption, introduction, training, etc.
- • As many countries still rely on paper-systems, the analysis should also look at the possibility of integrating paper forms with other electronic tools (e.g. scanned paper forms with optical character recognition).
- • Assess if the EMR/ EHR and telehealth applications can be integrated to enable clinicians to interact within a single platform.
- • Develop two country examples of an EMR/ EHR high-level investment concept note that can be used to solicit donor support and funding.
METHODS TO CARRY OUT THE ACTIVITY
In close collaboration with WHO and PHIN, the research team is expected to:
- Conduct a literacy review to assess existing studies and market and industry reviews on the topic (PubMed and other scientific journals, industry studies, international organization’s publications etc)
- Conduct a desktop review and data collection of all relevant material and information relating to the EMR/ EHR of the PICTs (update 2017 review though document review and consultations with PHIN network/HIS focal points)
- Conduct in-depth interviews with vendors and potentially with selected end-users
- The team will develop the study methodology and framework, including assessment matrix, to use for approval and will be submitted as part of the project’s Inception Report.
QUALIFICATIONS & EXPERIENCE
EDUCATION
Essential:
The composition and mix of team members must have postgraduate studies and training in public health, primary care, secondary care, tertiary care and digital health.
EXPERIENCE
Essential:
- • At least 15 years of working experience.
- • At least 5 years of international development work experience.
- • At least 5 years working with EMR, EHR and public health solutions.
Desirable:
At least 5 years working in low-resource clinical settings.
TECHNICAL SKILLS & KNOWLEDGE
- • Extensive knowledge and experience in implementing health information systems, particularly EMR, EHR and clinical information systems in low-resource settings.
- • Demonstrated understanding of interoperability across digital health solutions.
- • Demonstrated strong stakeholder relationship management skills to work with Pacific island countries.
LANGUAGES
English
COMPETENCIES
- • Communicating in a credible and effective way;
- • Producing results in a timely manner;
- • Moving forward in a challenging environment; and
- • Fostering integration and teamwork
ADDITIONAL INFORMATION:
Duration of Contract: 75 - 80 days
20% Inception Report by June 30, 2020
40% Draft Review by August 15, 2020
40% Final Report by October 2, 2020
APPLICATIONS
Qualified and interested specialists should submit their CV {for individual contractors} or Company Profile {for institutional applications} and Expression of Interest {cover letter} to the Supply Officer through WP RO UNGM at < wproungm@who.int > by 8 June 2020.
The cover letter should outline how their experience and qualifications make them a suitable candidate for this position and should include their proposed daily consultancy fee and availability.
Please use Tender Notice No. 108689 as subject to all submission. Only successful candidates will be contacted.