Standards and Guidelines for Electronic Medical Record Systems in ...

informatics skills in order to effectively perform these duties. Ensuring the availability of these
well-trained and motivated health workers to the team is critical to a successful implementation
and ongoing usage of a health information system.
The introduction of Electronic Medical Record systems has expanded the range of health workers
and competencies required to effectively run a comprehensive health care facility. However,
widespread adoption of EMR systems in resource-limited settings has been impeded by multiple
factors, including varied availability of staff with the technical and informatics skills to perform the
now expanded set of health information management responsibilities.
Training programs have traditionally focused on the use of paper record systems with little
emphasis given to electronic systems. However, Forster et al. (2008) noted a positive association
between the quality of data collected and training for data clerks and between the quality of data
and the number of hours spent on an electronic database by data clerks. 24
It is important to note that over-emphasis on the availability of a specific and scarce cadre of staff
(e.g. Health Records Information Officers (HRIOs) and data clerks) to determine EMR readiness
only prolongs the delay in the adoption of EMR. It is better to realize that different implementation
models will have different human resource requirements. The HR requirements for an EMR
installation will be determined by:
· The size of implementation - A multi-computer networked implementation model in a
provincial hospital with a patient load of 2000 patients will have different HR requirements
then a stand-alone implementation in a health center with a patient load of 200 patients.
· The functionality implemented in the EMR system - e.g. clinical data entry, patient
registration, patient billing, laboratory/pharmacy practice or data exchange, reporting, etc.
· How those functions are to be performed (workflow) and by whom - For example, will
data-entry clerks enter clinical data following the patient visit or do clinicians do this during
or following the visit; are any data scanned into the system or are all data elements entered
manually?
24 Forster, M., Bailey, C., Brinkhof, M. W., Graber, C., Boulle, A., Spohr, M., Balestre, E., May, M., Keiser, O., Jahnf,
A., & Eggera, M. (2008) Electronic medical record systems, data quality and loss to follow-up: survey of
antiretroviral therapy programmes in resource-limited settings. Bulletin of the World Health Organization 86, .
Standards and Guidelines for Electronic Medical Records Systems in Kenya 57