BACKGROUND AND OBJECTIVE

There are mixed reports on nurses’ satisfaction with electronic medical records (EMR) in literature, and facilitators and barriers to its adoption were reported frequently. A Philippine public tertiary hospital developed an EMR to facilitate remote access to patient charts outside its COVID-designated areas during the pandemic. This study aims to assess nurses’ satisfaction with EMR use in order to improve their user experience. The Delone and McLean Information System (D&M IS) Success Model was used as its framework. This offers a unique perspective to EMR adoption by accounting for the effects of the pandemic.

A descriptive, cross-sectional, quantitatively driven, concurrent mixed-methods design was employed. Nurses from the hospital were recruited for the survey (n=353) and the focus group discussions (n=14). Ethical approval was obtained prior to its conduct. Analysis was done through descriptive statistics, multiple linear regression, and thematic analysis. Data were integrated to appreciate the differences in their experiences from the point of adoption up to their current experiences.

Nurses initially faced challenges with the EMR when it was introduced, but improvements and continuous use have led to their current high satisfaction. Despite mandatory use and high usage scores, some daily tasks are still done manually. Use, length of service, number of patients handled, designation, and area of assignment were found to be associated with satisfaction. Thematic analysis highlighted several adoption prerequisites in this setup, including assessment of user competence and experience, and the provision of training, structural necessities, and organizational support.

This study found high use and satisfaction scores, aligning with the D&M IS Success Model, despite initial adoption challenges. Recommendations include maintaining high EMR use and improving efficiency, communication, and collaboration. Emphasis was placed on the provisions of better training and continuous feedback gathering.

BACKGROUND

Medical records provide a repository of patient information, physical examination, laboratory findings, and the outcomes of interventions. The completeness of data contained in the electronic medical record (EMR) is an important factor leading to health service improvement. Quality assurance (QA) activities have been utilized to improve documentation in electronic medical records.

To determine the effectiveness of QA interventions (feedback, workshop, and random monitoring system) in improving completeness of data entries in the EMR of resident physicians for COVID-19 teleconsultations.

This was a before-and-after study involving EMR entries of physician trainees on health care workers (HCWs) from March to October 2022 of the COVID-19 pandemic. A chart audit was conducted against a checklist of criteria for three months before and after the interventions. QA interventions included the provision of feedback on the results of the initial chart review; conducting a QA workshop on setting of standards, chart audit, data encoding, analysis, and presentation; and random monitoring/feedback of resident charting. The change in the level of completeness from pre- to post-intervention was computed, and the percentage of charts meeting the minimum standard of 90% completeness was likewise determined.

A total of 362 and 591 chart entries were audited before and after the interventions. The average percentage of completeness of medical records during initial consultation improved from 83% to 95% (p>0.05). The documentation of the reason for seeking consultation significantly increased from < 1% to 84%. The reporting of past exposure and level of risk decreased to 89% (p=0.001) in the initial consult and 12% (p=0.001) in the fit-to-work, respectively. Majority of the criteria for work clearance improved after the intervention. However, the average completeness of entries did not reach 90% post-intervention for fit-to-work consultations.

Feedback, quality assurance workshop, and random monitoring of electronic medical records are effective in increasing documentation practices for the chief complaint and dates of illness duration but showed non-significant increasing trend on overall percentage of EMR completeness for COVID-19 teleconsultations.

BACKGROUND

Primary care for pediatric patients focuses on providing comprehensive, accessible, and coordinated healthcare from the neonatal period to adolescence. The implementation and use of electronic medical records (EMR) in pediatric primary care facilities is an efficient strategy to gather necessary information on the epidemiology of common pediatric diseases in the Philippines.

This study aimed to determine the frequency distribution of pediatric diseases in a rural primary healthcare facility in the Philippines.

This cross-sectional study reviewed the EMR of all pediatric patients who consulted in a primary care facility in Samal, Bataan from April 2019 to March 2021. Data gathered include sex, age in years, chief complaint, diagnosis, and month of consultation. Data was summarized using descriptive statistics.

A total of 14,462 pediatric consults were recorded from April 2019 to March 2021. There were slightly more male patients (52.1%). The mean age of the patients was 6.5 years (standard deviation 5.22). The highest number of consults came from the 1- to 4-year-old age group (41.5%). The most common chief complaints were cough (45.9%), fever (25.5%), and colds (24.9%). The most frequent diagnoses were upper respiratory tract infections (47.4%), followed by lower respiratory tract infections (6.9%), and skin and soft tissue infections (5.3%). Majority of the consults for respiratory tract infections, skin and soft tissue infections, gastroenteritis, asthma, and dermatitis were in the 1- to 4-year-old age group. Urinary tract infections and otitis media or externa were recorded more frequently in the 5- to 9-year-old age group.

Respiratory tract infections, followed by skin and soft tissue infections, were the most frequently identified diseases in children consulting a primary care facility at a rural site in the Philippines. The most common chief complaints, defined as the primary reason for seeking consult, were cough, fever, and colds. Data was gathered through EMR review, which may aid in the planning of programs and policies to improve primary care service delivery.

Background and Objective: There are mixed reports on nurses’ satisfaction with electronic medical records (EMR) in literature, and facilitators and barriers to its adoption were reported frequently. A Philippine public tertiary hospital developed an EMR to facilitate remote access to patient charts outside its COVID-designated areas during the pandemic. This study aims to assess nurses’ satisfaction with EMR use in order to improve their user experience. The Delone and McLean Information System (D&M IS) Success Model was used as its framework. This offers a unique perspective to EMR adoption by accounting for the effects of the pandemic. Methods: A descriptive, cross-sectional, quantitatively driven, concurrent mixed-methods design was employed. Nurses from the hospital were recruited for the survey (n=353) and the focus group discussions (n=14). Ethical approval was obtained prior to its conduct. Analysis was done through descriptive statistics, multiple linear regression, and thematic analysis. Data were integrated to appreciate the differences in their experiences from the point of adoption up to their current experiences. Results: Nurses initially faced challenges with the EMR when it was introduced, but improvements and continuous use have led to their current high satisfaction. Despite mandatory use and high usage scores, some daily tasks are still done manually. Use, length of service, number of patients handled, designation, and area of assignment were found to be associated with satisfaction. Thematic analysis highlighted several adoption prerequisites in this setup, including assessment of user competence and experience, and the provision of training, structural necessities, and organizational support. Conclusions This study found high use and satisfaction scores, aligning with the D&M IS Success Model, despite initial adoption challenges. Recommendations include maintaining high EMR use and improving efficiency, communication, and collaboration. Emphasis was placed on the provisions of better training and continuous feedback gathering.
Human ; electronic health records ; health information systems ; nurses ; pandemics ; Philippines

BACKGROUND

Evaluation of primary care allows for identification of problems in the healthcare system, such as poor health outcomes, inappropriate health services, overuse of unnecessary resources, or underuse of recommended strategies. Assessment of adherence to existing clinical practice guidelines as quality indicators is critical for evaluating the effectiveness of primary care and shaping healthcare policies.

To determine the adherence of primary care providers to existing practice guidelines for common pediatric concerns in remote, rural, and urban areas in the Philippines.

This cross-sectional study included data from the electronic medical records (EMR) of patients aged 19 years and below who consulted at the three pilot sites of the Philippine Primary Care Studies (PPCS) from January to December 2019. Relevant demographic data and quality indicator measures (e.g., immunization history, adolescent smoking history, medication and supplement prescription) were extracted from the EMR by the PPCS data management team. Adherence to existing guidelines on pediatric history taking and management of common illnesses (e.g., diarrhea, upper respiratory tract infections, malnutrition) was evaluated.

This study included 8,724 pediatric patients seen across the three pilot sites from January to December 2019. Immunization history was taken in only 0.4% of pediatric patients. Smoking history was taken in only 6.8% of adolescent patients. Zinc was prescribed in only 40.1% of patients with diarrhea. No infants were prescribed with vitamin A, while iron was prescribed in only 2.5% of children and 3% of adolescent females. In contrast to the recommendations of existing guidelines, antibiotics were prescribed in 38.5% of patients with AGE and 62.5% of patients with viral URTI. Montelukast was prescribed as first-line asthma treatment in 4.7% of cases. Multivitamins were prescribed in 57.2% of all pediatric patients.

Overuse of inappropriate medications and underuse of appropriate interventions were observed in this study. There was low adherence to evaluation of pediatric immunization history, adolescent smoking history, zinc supplementation for diarrhea, and iron and vitamin A supplementation among identified vulnerable population groups. Over prescription of the following were observed: (1) antibiotics for acute gastroenteritis and probable viral URTI, (2) multivitamins for the general pediatric population, and (3) montelukast among newly diagnosed asthma patients.

BACKGROUND AND OBJECTIVES

The adoption of electronic medical records (EMRs) in the Philippines has been initiated and adjusted since the last decade through the Philippine eHealth Agenda framework. EMRs are known to improve clinical management and have been widely adopted in advanced economies. However, empirical research on EMR implementation remains limited. This study aims to determine how public primary health care facilities in the country interacted with EMRs before and during the COVID-19 pandemic to understand EMR adoption.

More than 270,000 records generated from EMR usage logs in six rural primary health facilities in Western Visayas were analyzed. Average time of EMR use during work hours was estimated and compared before and during the pandemic. EMR adoption based on specific EMR features used was also determined.

In 2020, EMR use ranged from less than one hour to more than eight hours in selected rural health units (RHUs). There was a statistical increase and decrease in use of features during the pandemic. Some EMR users had efficient use indicated by complete adoption of EMR features although such features were not as frequently used as those pertaining to basic adoption.

This study demonstrates that for EMR use in rural settings, progressive use from basic to complete may vary among users. Public health emergencies such as a pandemic may also affect EMR use. Future research directions should explore other mechanisms which affect user behavior and encourage full adoption of technology such as use of games or non-monetary incentives.

Background: Turnaround time is an integral component of primary healthcare and is a key performance indicator of healthcare delivery. It is defined as the time patients spend during a healthcare facility visit. In this study, turnaround time is defined as the time elapsed from registration to the end of consultation. Objectives: This study aimed to determine the turnaround time of consults in the primary care system in a rural site in the Philippines, and compare turnaround time during the pre-pandemic and COVID-19 pandemic periods. Methods: This is a retrospective cohort study of patients seen at the primary care facility under the Philippine Primary Care Studies (PPCS) rural site from April 2019 to March 2021. Patients included in this study were chosen through random sampling. Electronic medical records (EMR) of these patients were reviewed. Turnaround time was computed electronically from time of registration to end of consultation. Descriptive statistics was used to summarize data and report turnaround time. The turnaround time before and during the pandemic was compared using an independent sample t-test (if normally distributed) or Mann Whitney U test (if not normally distributed). A p-value of <0.05 was considered statistically significant. Results: A random sample of 342 patients out of the total 45,501 patient consults seen at the rural primary healthcare facility from April 2019 to March 2021 were included in this study. The median turnaround time was 29.0 minutes (interquartile range [IQR] 68.3), with range of 0.9 to 437.2 minutes. During the pre-pandemic period, the median turnaround time of consults is 29.3 minutes (IQR 70.4) which is 1.8 minutes longer than the pandemic period which showed median turnaround time of 27.5 minutes (IQR 72.7). The difference between the two time periods was not statistically significant (P = 0.39). Conclusion The study showed that the median turnaround time of medical consults was 29.0 minutes, which was shorter by 80 minutes compared to other published Philippine studies. The turnaround time did not differ significantly in the pandemic and prepandemic period, despite new policies and systems that were implemented during the pandemic.
primary care ; electronic medical records ; pandemic ; Philippines

Introduction: There is increasing interest in innovation development and management in the Philippines, especially in the last decade. In the advocacy for universal hearing health, the HeLe, “Hearing for Life’’ Research Program was implemented. HeLe developed novel telehealth technologies and field tested a proof-of-concept service delivery model to improve provision of newborn hearing screening and intervention services in the Philippines. Objective: As the HeLe research period concludes, this appraisal was organized to document and assess the health information technology systems of the HeLe. Methods: The evaluation follows the elements of the Centers for Disease Control and Prevention (CDC) guidelines for evaluation of public health surveillance systems. It centers on the status of the eHealth-based components of the HeLe NHS interventions: HeLe NHS module in the Community Health Information Tracking System (CHITS) electronic medical records system, the Tele-Audiology module in National Telehealth System (NTS), and the HeLe NHS registry. The evaluation is based on interviews of key HeLe research staff and documentation review. Results: The HeLe system has a stable, SQL-Server-based architecture. It is a secure, web-based system with clean separation of back-end database and front-end Web, using Secure Socket Layer (SSL) technology. Standardization of data via mapping ensures reliable, comparable measures. HeLe demonstrates that NHS data collected by the HeLe NHS device can be sent to, stored in, and extracted from the CHITS electronic medical record system and exchanged across platforms. Where actual patient and NHS data were available, this HeLe system is validated to be efficacious to capture and seamlessly exchange data across various eHealth platforms. These eHealth technologies are described to be at Technology Readiness Level 5, “technologies are validated in a relevant environment”. The HeLe program, however, needs to address completeness in documentation as a standard practice, if only to ensure better management of risks introduced by novel eHealth systems in patient care. The CDC public health surveillance checklist used for this assessment is useful in identifying gaps in research management for the HeLe inventors. It is recommended to be incorporated to be standard and implemented early in the next iteration of the HeLe research. Conclusions Overall, the HeLe technologies, in this initial stage of research, have achieved the purpose for which they were developed. As a novel technologybased NHS system, HeLe is a potentially powerful tool to assist in monitoring newborn hearing disease caseloads by community-based primary care clinics, NHS facilities, and hospitals that provide definitive medical services. As other health systems strengthening reforms take root in the Philippines, secure exchange of data electronically across the country would depend on sound technologies, including those used in hearing health. This paper can be instructive to the emerging research community in the eHealth and biomedical development space especially in resource-challenged settings. Likewise, lessons can reinforce institutional support from research agencies, clinicians, and state/county or subnational health departments for policy and resource mobilization to better manage those identified with congenital hearing loss.
Telemedicine ; Electronic Health Records

Humans ; Electronic Health Records ; Phenotype ; Renal Insufficiency, Chronic/epidemiology* ; Databases, Factual ; Algorithms

The paper analyzes the specificity of term recognition in acupuncture clinical literature and compares the advantages and disadvantages of three named entity recognition (NER) methods adopted in the field of traditional Chinese medicine. It is believed that the bi-directional long short-term memory networks-conditional random fields (Bi LSTM-CRF) may communicate the context information and complete NER by using less feature rules. This model is suitable for term recognition in acupuncture clinical literature. Based on this model, it is proposed that the process of term recognition in acupuncture clinical literature should include 4 aspects, i.e. literature pretreatment, sequence labeling, model training and effect evaluation, which provides an approach to the terminological structurization in acupuncture clinical literature.
Acupuncture Therapy ; Electronic Health Records ; Natural Language Processing