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Electronic health record system (EHRS) is an important healthcare innovation associated with many controversies about the benefits and challenges to different stakeholders. The aim of this study was to investigate the utility of EHRS by outpatient physicians in Macao and to identify, in their opinions, the significance of EHRS on health institutes, patients, and physicians. Semi-structured interviews were conducted with 32 physicians who worked in the outpatient department. The interview data showed that 78 % physicians interviewed used EHRS frequently during their daily practice despite individual preferences of documentation methods. They agreed that systemic health record offered by EHRS allowing smooth communication was beneficial to the health institutes, patients and physicians.

However, privacy and confidentiality concerned both the health institutes and patients. Inefficiency of the EHRS that only allowed retrieval of limited medical information of the patients hindered physicians’ acceptability of EHRS. It was also suggested that the health institutes should take into consideration interests of different stakeholders when designing and implementing EHRS.

Challenges for physicians

As the main users of EHRS, the physicians were concerned very much about the efficiency of the system to facilitate their daily work. The main challenges for the

physicians to use the EHRS were the slow typing process without any templates for guidance or standardization. There were complaints about numerous interfaces or settings to check the past records, which affected the work efficiency. Two senior physicians complained that EHRS was more time consuming than paper records. They explained that this might be due to their slow typing and lack of template. Furthermore, 4 of 32 physicianssuggested the standardization of languages used for documentation was a concern. In the government health institutes, the languages of documentation were in English or Portuguese, while the private institutes mainly used Chinese or English. Moreover, some physicians mentioned that only limited individual medical information could be retrieved from the EHRS due to incomplete data input by other physicians and laboratory technicians. As a result, some medical procedure needed to be repeated for confirmation of disease progression, which was inefficient for work.

Recommendation

Like many regions and countries, has been dedicated to improving healthcare services. EHRS is considered as one of the essential tools for healthcare innovation which requires maintenance and improvement to consummate current service and meet future needs. In order to ensure the development of EHRS matches the needs of users, input from various stakeholders is essential for appropriate and timely improvement. Among all stakeholders, physician’s involvement is believed to be the most influential. In this study, physicians shared their opinions about the utility of EHRS and their concerns, as well as what they see as the concerns of the administrators in the health institutes and their patients. It is anticipated that, based on the findings of this study, more emphasis would be made on improving the efficiency of the system, increasing IT human resources, providing better training to physicians and updating the system to meet the international standard to meet physicians’ expectations. At the same time, communications between the patients and the physicians should be encouraged further to build the patients’ trust in EHRS. Having the administrators aware and agreed on the suggestions was believed to be the key to success of the EHRS. In the future, with an efficient EHRS, it was believed that better disease management could be achieved. Moreover, EHRS could also allow patient-centered interactions such as incorporation of health-related quality of life modules which could help to improve the quality of care.

Reference

Chao, W. C., Hu, H., Ung, C. O. L., & Cai, Y. (2013). Benefits and challenges of electronic health record system on stakeholders: a qualitative study of outpatient physicians. Journal of medical systems, 37(4), 9960.
Abramson, E. L., Patel, V., et al., Physician experiencestransitioning between an older versus newer electronic health record for electronic prescribing. Int. J. Med. Inform. 81(8):539–548,2012.
Hatton, J. D., Schmidt, T. M., and Jelen, J., Adoption of electronichealth care records: Physician heuristics and hesitancy. ProcediaTechnol. 5(4):706–715, 2012.

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