The aim of this study, carried out in September 2009, was to discover physician portal users’ opinions of the usefulness of electronic medical records in Latin America.
There is now enough evidence to say definitively that electronic health records improve quality of care, and save on administration costs [1].
Electronic medical records or electronic health records (EHR) are only one very important factor in current health information systems [2], we make this distinction because the component is often confused with the overall medical record and health information system.
The goal of electronic health records is to acquire, store, retrieve, process and exchange clinical data related to a patient [3, 4].
According to the project group GEHR (Good European Health Records) medical records should be a combination of data and facts recorded in handwritten form, graphically or in electronic format in order to store and preserve knowledge [5].
A recent report from the Institute of Medicine (IOM) in the United States, has updated its 90s definition, stating that electronic medical records should be a longitudinal collection of electronic information on people’s health where health information is defined as information relevant to the health of an individual and the health care given to them by any health team member. It further states that these records should allow immediate electronic access to personal health information only to authorized users and must provide knowledge base and support systems for making decisions that improve the quality, safety and efficiency of patient care [6].
Clearly, being limited to paper records seriously hampers attempts to meet the current objectives of the medical record.
Some observational studies conducted with physicians using paper records, found that there are practical, logistical and organizational limitations which reduce the effectiveness of traditional record storage and hamper attempts to organize the growing number of medical observations in the registry. Electronic Health Records (EHR) are designed to overcome many of these limitations, as well as to provide additional benefits that can not be obtained through a static view of the information [4, 7, 8].
These technologies have spread rapidly in the developed world, with varying degrees of success and acceptance by professionals and many studies have evaluated their utility, focusing either on the use or the choice of system implemented [9-11] but in much of Latin America, EHR has not spread as fast as in the rest of the world [12], with different authors putting this down to both economic conditions and resistance from health personnel [13-16 ].
Several studies of the usefulness of electronic medical records have been published in the United States and Europe [17-19], showing favorable results in terms of use value and degree of acceptance of these systems, although many of these studies were conducted by marketers of electronic medical records systems, a fact that could skew the results, although they still contain valid epidemiological analysis. Furthermore, other studies exist, particularly in Europe, which are not linked to product marketing. However, the usefulness of EHR has seldom been expressed in numbers, and we have not found evidence that it has been studied in this way in Latin America.
The aim of this study was to discover physician portal users’ opinions of the usefulness and use of electronic medical records in Latin America.
Materials and methods
The work was carried out at the Intramed physician portal (www.intramed.net). The system’s site enables users to target content based on the specialty of the practitioner and has 480 home pages in 32 medical specialties in 15 countries. Each of these dynamic specialized pages contains structured content with news, medical articles, medical education and events. There is also content common to all medical specialties and non-medical general interest stories.
The study was conducted via a structured survey entitled «»e-research»», research which uses online methodology in order to obtain results [20]. The questionnaire was available on-line to registered users of the site between July 15 and August 15, 2008. Intramed is a medical scientific content network spread throughout Latin America, and has more than 250,000 registered users and a use frequency of approximately 50,000 distinct users per month.
The study was limited to Internet users with access to the website. It contained electronic cross-section, description and survey features, structured formats and optional sections for further notes.
Measuring instrument: a multiple choice survey (on a Lickert scale) designed using structured analysis of existing studies and models of electronic medical record systems provided by commercial companies.
The survey was available to all users once they entered the Intramed portal, after providing a username and password. When presented with the survey, users had the option to answer immediately, to answer it later or not to answer it at all, with the browser then navigating to the web page the user requested. Users were not asked to participate in the survey again.
If they agreed to fill out the survey, users were presented with a text explaining the purpose of the study and requesting the user’s agreement to the data they provide being used in the research. The answers were kept in a database which ensured that demographic information, selected options and personal data were kept private. This strategy preserved the privacy of the people who answered the survey.
The survey assessed users’ opinions regarding the usefulness of electronic medical records in the following domains:
A. EHR functions themselves: patient development chart, medical problem list.
B. Documentation Functions: recording lab results, registration of images, scanning and storage of physical documents in the EHR, documentation of vital signs.
C. Functions related to preventative care and decision-making support; immunization records, warnings of allergies recorded, reminders of preventative practices.
D. Prescription and ordering functions: recording medication, consultation of the medication chart and printing prescriptions.
E. Functions related to consultants: receiving replies from professionals consulted.
F. Health education and access by patients (PHR – Personal Health Record): sending reminders to patients by phone or email, making it possible for patients to access information from their history with prior approval of the professional, the creation of an education and information program which can be printed out by patients.
G. Administrative functions: using administrative data from other centers via the system, patient data coverage.
H. Inter-operability: the ability to encode patient diagnosis, sharing information recorded about patients with other useful professionals.
It also requested survey takers to provide contextual information, including:
• The year they graduated from university.
• If the respondent has worked in more than one health facility.
• If they practice in the private or public realm or both.
If they use a personal electronic device (PDA) of any kind and whether they use a computer system to record information about their patients.
• In cases where the answer is affirmative, the type of system they used.
• What they considered to be the main weakness of their system.
• The training method they received to get started.
• The presence of technical assistance.
• The type of record used.
• Finally, if they continue using the traditional paper records system, and if so, if they would consider using an EHR.
Daniel Flichtentrei (a), Florencia Braga (a), Darío García (a), Jorge Jamsech (a), Carlos Otero (b)
(A) Physician Portal Intramed
(B) Area Medical Informatics, Hospital Italiano de Buenos Aires
The aim of this study, carried out in September 2009, was to discover physician portal users’ opinions of the usefulness of electronic medical records in Latin America.
There is now enough evidence to say definitively that electronic health records improve quality of care, and save on administration costs [1].
Electronic medical records or electronic health records (EHR) are only one very important factor in current health information systems [2], we make this distinction because the component is often confused with the overall medical record and health information system.
The goal of electronic health records is to acquire, store, retrieve, process and exchange clinical data related to a patient [3, 4].
According to the project group GEHR (Good European Health Records) medical records should be a combination of data and facts recorded in handwritten form, graphically or in electronic format in order to store and preserve knowledge [5].
A recent report from the Institute of Medicine (IOM) in the United States, has updated its 90s definition, stating that electronic medical records should be a longitudinal collection of electronic information on people’s health where health information is defined as information relevant to the health of an individual and the health care given to them by any health team member. It further states that these records should allow immediate electronic access to personal health information only to authorized users and must provide knowledge base and support systems for making decisions that improve the quality, safety and efficiency of patient care [6].
Clearly, being limited to paper records seriously hampers attempts to meet the current objectives of the medical record.
Some observational studies conducted with physicians using paper records, found that there are practical, logistical and organizational limitations which reduce the effectiveness of traditional record storage and hamper attempts to organize the growing number of medical observations in the registry. Electronic Health Records (EHR) are designed to overcome many of these limitations, as well as to provide additional benefits that can not be obtained through a static view of the information [4, 7, 8].
These technologies have spread rapidly in the developed world, with varying degrees of success and acceptance by professionals and many studies have evaluated their utility, focusing either on the use or the choice of system implemented [9-11] but in much of Latin America, EHR has not spread as fast as in the rest of the world [12], with different authors putting this down to both economic conditions and resistance from health personnel [13-16 ].
Several studies of the usefulness of electronic medical records have been published in the United States and Europe [17-19], showing favorable results in terms of use value and degree of acceptance of these systems, although many of these studies were conducted by marketers of electronic medical records systems, a fact that could skew the results, although they still contain valid epidemiological analysis. Furthermore, other studies exist, particularly in Europe, which are not linked to product marketing. However, the usefulness of EHR has seldom been expressed in numbers, and we have not found evidence that it has been studied in this way in Latin America.
The aim of this study was to discover physician portal users’ opinions of the usefulness and use of electronic medical records in Latin America.
Materials and methods
The work was carried out at the Intramed physician portal (www.intramed.net). The system’s site enables users to target content based on the specialty of the practitioner and has 480 home pages in 32 medical specialties in 15 countries. Each of these dynamic specialized pages contains structured content with news, medical articles, medical education and events. There is also content common to all medical specialties and non-medical general interest stories.
The study was conducted via a structured survey entitled «»e-research»», research which uses online methodology in order to obtain results [20]. The questionnaire was available on-line to registered users of the site between July 15 and August 15, 2008. Intramed is a medical scientific content network spread throughout Latin America, and has more than 250,000 registered users and a use frequency of approximately 50,000 distinct users per month.
The study was limited to Internet users with access to the website. It contained electronic cross-section, description and survey features, structured formats and optional sections for further notes.
Measuring instrument: a multiple choice survey (on a Lickert scale) designed using structured analysis of existing studies and models of electronic medical record systems provided by commercial companies.
The survey was available to all users once they entered the Intramed portal, after providing a username and password. When presented with the survey, users had the option to answer immediately, to answer it later or not to answer it at all, with the browser then navigating to the web page the user requested. Users were not asked to participate in the survey again.
If they agreed to fill out the survey, users were presented with a text explaining the purpose of the study and requesting the user’s agreement to the data they provide being used in the research. The answers were kept in a database which ensured that demographic information, selected options and personal data were kept private. This strategy preserved the privacy of the people who answered the survey.
The survey assessed users’ opinions regarding the usefulness of electronic medical records in the following domains:
A. EHR functions themselves: patient development chart, medical problem list.
B. Documentation Functions: recording lab results, registration of images, scanning and storage of physical documents in the EHR, documentation of vital signs.
C. Functions related to preventative care and decision-making support; immunization records, warnings of allergies recorded, reminders of preventative practices.
D. Prescription and ordering functions: recording medication, consultation of the medication chart and printing prescriptions.
E. Functions related to consultants: receiving replies from professionals consulted.
F. Health education and access by patients (PHR – Personal Health Record): sending reminders to patients by phone or email, making it possible for patients to access information from their history with prior approval of the professional, the creation of an education and information program which can be printed out by patients.
G. Administrative functions: using administrative data from other centers via the system, patient data coverage.
H. Inter-operability: the ability to encode patient diagnosis, sharing information recorded about patients with other useful professionals.
It also requested survey takers to provide contextual information, including:
• The year they graduated from university.
• If the respondent has worked in more than one health facility.
• If they practice in the private or public realm or both.
If they use a personal electronic device (PDA) of any kind and whether they use a computer system to record information about their patients.
• In cases where the answer is affirmative, the type of system they used.
• What they considered to be the main weakness of their system.
• The training method they received to get started.
• The presence of technical assistance.
• The type of record used.
• Finally, if they continue using the traditional paper records system, and if so, if they would consider using an EHR.
Daniel Flichtentrei (a), Florencia Braga (a), Darío García (a), Jorge Jamsech (a), Carlos Otero (b)
(A) Physician Portal Intramed
(B) Area Medical Informatics, Hospital Italiano de Buenos Aires
