Article

Assessing the process of designing and implementing electronic health records in a statewide public health system: The case of Colima, Mexico

Information Center for Decisions in Public Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
Journal of the American Medical Informatics Association (Impact Factor: 3.5). 09/2012; 20(2). DOI: 10.1136/amiajnl-2012-000907
Source: PubMed

ABSTRACT

The findings of a case study assessing the design and implementation of an electronic health record (EHR) in the public health system of Colima, Mexico, its perceived benefits and limitations, and recommendations for improving the implementation process are presented. In-depth interviews and focus group discussions were used to examine the experience of the actors and stakeholders participating in the design and implementation of EHRs. Results indicate that the main driving force behind the use of EHRs was to improve reporting to the two of the main government health and social development programs. Significant challenges to the success of the EHR include resistance by physicians to use the ICD-10 to code diagnoses, insufficient attention to recurrent resources needed to maintain the system, and pressure from federal programs to establish parallel information systems. Operating funds and more importantly political commitment are required to ensure sustainability of the EHRs in Colimaima.

Download full-text

Full-text

Available from: David Hotchkiss, Aug 21, 2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: Electronic health records (EHRs) are gaining attention and interest in health systems worldwide. This chapter describes the benefits of EHRs compared to their paper-based predecessor, and the problems and potential uses of EHRs. Rehabilitation for PWDs is used as an example in this chapter.
    No preview · Chapter · Jan 2013
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE: Applying the science of networks to quantify the discriminatory impact of the ICD-9-CM to ICD-10-CM transition between clinical specialties. MATERIALS AND METHODS: Datasets were the Center for Medicaid and Medicare Services ICD-9-CM to ICD-10-CM mapping files, general equivalence mappings, and statewide Medicaid emergency department billing. Diagnoses were represented as nodes and their mappings as directional relationships. The complex network was synthesized as an aggregate of simpler motifs and tabulation per clinical specialty. RESULTS: We identified five mapping motif categories: identity, class-to-subclass, subclass-to-class, convoluted, and no mapping. Convoluted mappings indicate that multiple ICD-9-CM and ICD-10-CM codes share complex, entangled, and non-reciprocal mappings. The proportions of convoluted diagnoses mappings (36% overall) range from 5% (hematology) to 60% (obstetrics and injuries). In a case study of 24 008 patient visits in 217 emergency departments, 27% of the costs are associated with convoluted diagnoses, with 'abdominal pain' and 'gastroenteritis' accounting for approximately 3.5%. DISCUSSION: Previous qualitative studies report that administrators and clinicians are likely to be challenged in understanding and managing their practice because of the ICD-10-CM transition. We substantiate the complexity of this transition with a thorough quantitative summary per clinical specialty, a case study, and the tools to apply this methodology easily to any clinical practice in the form of a web portal and analytic tables. CONCLUSIONS: Post-transition, successful management of frequent diseases with convoluted mapping network patterns is critical. The http://lussierlab.org/transition-to-ICD10CM web portal provides insight in linking onerous diseases to the ICD-10 transition.
    No preview · Article · May 2013 · Journal of the American Medical Informatics Association
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Finding the factors contributing to the successful implementation of Health Information Technology (HIT) can help relieve the stress on healthcare systems worldwide caused by e.g. aging populations. This research reviewed the existing literature and identified 16 success factors for HIT implementation, of which one, the influence of external environment, was not found by prior reviews. This factor is crucial in HIT implementation because healthcare organizations in many countries are highly regulated by government policy and dependent on subsidies. The existing research showed a clear tendency for qualitative empirical work in HIT implementation, and in particular, on individual case studies, creating the need for future quantitative research on HIT implementation success factors. The review also suggested a pyramidal research approach and a taxonomy which shows the interactions of different stakeholders with implementers. These can serve as a reference for scholars and implementers of HIT in studying HIT implementation success factors.
    Full-text · Conference Paper · Jan 2014
Show more