By: Electronic Medical Records in the Philippines Issues and Challenges ROMSTY C. SANTOS Master of Science in Health Informatics, University of the Philippines Manila

1.  What are the implementation issues and challenges of some of the leading EMR providers in the country?

2.  Lack of manpower No designated encoderin RHUs Fast turnoverof health workers Some midwives or nurses are at retirement age Some are not techy or computer savvy or literate Management issues in the LGU Some LCEs do not prioritizehealth Health workers are overburdened of tasks Instead of encoding data, they would prefer to maximize patient services Lack of resources, e.g. computer units and internet, due to lack of fundsor the area doesn't have internet connection such as GIDAsites

3. Legalware. Healthcare is multi-disciplinary: policies for health information exchange are not yet in place. Specific policies related to security, privacy and confidentiality of patient information are not yet laid down: some informatics pessimists are unconvinced that EMRs are good/efficient tools hardware. Poor hardware maintenance. Regular budget allocation to replace parts/units. 

Network problems, i.e. IP conflict and slow internet connectivity software. Local technical expertise to troubleshoot software-related issues. Health care data requirements are dynamic/ever changing: costly for some LGUs to budget for customizations peopleware.

4. Intended users Making the system relevant to them is more than just informing them. Users need to actually use it in their workflow. Until such time that they experience the full cycle: from recording, reminding, prescribing and use it for decision making, etc. then it is as of now just a database of patient information. 

Policy EMR providers listen to what DOH, PHIC and DOST require. However, delays in implementation, changes in administration are set backs. We go to the field promising that the system is relevant for claims yet it remains a promise after two years. Partners As a private provider of EMRS, we also need to ensure that our partners are satisfied with our work. 

Sometimes, there is already scope creep and we can not avoid including the work as it becomes relevant to the project based on circumstances. Technology As implementation plans change and slow down, technology on the other hand changes fast. We need to constantly upgrade which increases the cost of maintenance even before ROI kicks in. Sustainability We need to include a model for sustainability despite the software being free as there are real costs in maintaining the system.

5. Lack of funding support from the national government Weak policy Weak infrastructure environment.

6. Sustainability (unlike pharmacies, PHIC IT support are channeled to LGUs, and difficult to negotiate individually) Training and support for users Hardware for health workers

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