CHAPTER 2

Review of Related Literature

Overview

In order to understand the concepts associated with computer based records management

systems, it is vital to inspect and analyze published materials from experts regarding the field.

The purpose of this review is to obtain certain information as to how the creation of the program

should be done based on the past studies and based on the perspective of some experts.

RELATED LITERATURE

This section presents both foreign and local literatures relevant to the study. This relevance is

shown by the proponents in order to give more reason and understanding of the preposition.

LOCAL LITERATURE

Electronic Medical Records Urgently Required

Using technology in managing records is potentially a game-changer in the healthcare

industry. Its only inevitable that people start to realize the need to move patient medical records

from paper to electronic format.

According to inquirer.net, In the Philippines, because most hospitals and physicians do not yet

have electronic medical records (EMR), errors, injuries, accidents, and acquired infections in a

hospital are not yet reported and published. But we should all be concerned about hospital safety

because the statistics from the United States are scary.

Many US hospitals have safety records that wouldnt be accepted in any other industry. Consider

the statistics: As many as 440,000 people die every year from hospital errors, injuries, accidents

and infections. In a day alone, more than 1,000 people will die because of a preventable hospital

error. Every year, one of every 25 patients develops an infection while in hospitalan infection

that doesnt have to happen. These statistics are from the Hospital Safety Score organization, a

nonprofit business group called Leapfrog.

To improve healthcare hospitals, public health centers, and private medical offices, we

should require an EMR system with relational data fields so research and outcome studies can be

done with a few clicks or taps. The pen-and-paper style of record-keeping should be abandoned

because of the difficulty and high cost of doing research with this dysfunctional system.

Hospitals and physicians should be given tax incentives to have EMR. We can set 2020 as a

target year for all. Those without EMR will not be paid by PhilHealth and other private

insurances for their services.

(http://opinion.inquirer.net/80860/electronic-medical-records-urgently-required )

Electronic Medical Records Act of 2010

During the 15th Congress, the Senate Bill No. 2516 was filed on September 14, 2010 by Manuel

"Lito" M. Lapid. It is an act making available electronic medical records of all patients of

hospitals and clinics establishing for this purpose electronic medical record center under the

Department of Health, appropriating funds therefore and for other purposes.

(http://www.senate.gov.ph/lis/bill_res.aspx?congress=15&q=SBN-2516)

EMR/ EHR Adoption in the Philippines

 With technology getting less expensive and more powerful, there are more reasons for

hospitals and physicians to universally use Electronic Health Records.

The eHealth Innovations for Universal Health Care summit has just recently concluded. An eye

opener for the uninitiated, the eHealth summit offered valuable insights into the Philippines

eHealth masterplan 2014 and beyond.

We caught up with folks in the health IT community to get their thoughts on information and

communication technologies that will play critical roles in transforming the countrys health

system.

According to exist.com, With the Philippine Health Information Exchange (PHIE) targeted to be

operational by December 2014, means many hospitals and health facilities will be adopting

electronic medical record solutions. We dont have the aggregate number but, we hear about a

number of EMR system implementations, such as the Philippine Council for Health Research

and Development of the DOSTs eHealth Tablet that was initially deployed to 10 healthcare

facilities around the Philippines. Wed be very interested to get some information on EMR usage

in the Philippines.

(https://www.exist.com/healthcare-it-trends-in-philippines/)

Accessibility of EHR

Electronic medical record system, CHITS, can retrieve patient record in five seconds - expert

In a recent study from Quezon City, the paper record retrieval time was decreased from 2.41

minutes to less than 5 seconds, revealed Dr. Marie Irene Sy, National Project Manager for

Community Health Information Tracking System (CHITS) of the National Telehealth Center
(NTHC) in her presentation during the University of the Philippines National Institutes of

Health (UP-NIH) research forum last 14 June 2012.

The development of CHITS has resulted in increased efficiency of health workers, allowing

them to spend more time for patient care, improved data quality; streamlined records

management; and data-guided decision-making, both operationally and strategically, Dr. Sy

added.

In the past, health center staff members sort through a roomful of envelopes containing patient

records, which takes an average of four to five minutes depending on the availability of the

record. When the record is not found, a new record will be made for which the patient will have

to pay an extra cost. With CHITS, searching for a patient's record upon admission takes just a

few seconds to retrieve. Records in the form of lab requests, results, and reports (daily service

reports, census for number of vaccinations, supplies, etc.) can be generated automatically.

CHITS, an electronic medical record (EMR) specifically designed for the community health

centers in the Philippines, was developed through a collaborative and participative process

involving health workers and the Information and Communication Technology (ICT)

community, using the primary health care approach and guided by the open source philosophy.

(http://www.pchrd.dost.gov.ph/index.php/news/2726-electronic-medical-record-system-

chits-can-retrieve-patient-record-in-five-seconds-expert)
FOREIGN LITERATURE

EHR on productivity

A cluttered desk leaves them scrambling for pens, papers and important numbers. When

your employees have easy access to their workplace essentials, they can spend more time on

tasks that increase profitability. Having a clean work area minimizes distractions and allows your

employees to focus on the duties at hand. In this way, you get a bigger return on your labor

investment, improving your bottom line.

As the use of electronic health records increases, it becomes necessary to address their global

impact on nurses' productivity in hospitals. A retrospective cross-sectional study was conducted

to explore the impact of electronic health records on nurses' productivity and to examine whether

the impacts are moderated through case-mix index or adjusted patient-days. Two sources of data

were linked and analyzed for years 2011 and 2012: the American Hospital Association survey

and the Centers for Medicare & Medicaid Services data. Almost two-thirds of the respondent

hospitals in both years (63.9% in 2011 and 68.4% in 2012) had a high electronic health record

index (5). Hospitals with higher penetration of electronic health records had more RNs

employed (coefficient=0.234, P=.002) compared with hospitals with low penetration of

electronic health records, even when controlling for adjusted patient-day volumes. This

difference decreased for hospitals with higher case-mix index values. The study findings fail to

suggest any financial savings or superior productivity in nurses due to usage of electronic health

records.
A systematized type of record is the best thing to have to improve ones productivity. If

everything is in an ordered manner, it is easier to retrieve and collect the data. Your employees

need an organized space to perform their jobs efficiently.

(https://www.ncbi.nlm.nih.gov/pubmed/22411416)

Patients Safety

It is important for the hospital to take full responsibilities when it comes to their patients

safety. Keeping medical records is a crucial part in making that possible. Having an organized

system can make a huge impact when it comes to making sure that every detail is in place.

According to an article from The New England Journal of Medicine, Electronic health

records (EHR) are essential to improving patient safety. Hospitals and health care providers are

implementing EHRs rapidly in response to the American Recovery and Reinvestment Act of

2009. The number of certified EHR vendors in the United States has increased from 60 to more

than 1000 since mid-2008. Recent evidence has highlighted substantial and often unexpected

risks resulting from the use of EHRs and other forms of health information technology. These

concerns are compounded by the extraordinary pace of EHR development and implementation.

Thus, the unique safety risks posed by the use of EHRs should be considered alongside the

potential benefits of these systems.

(http://www.nejm.org/doi/full/10.1056/NEJMsb1205420#t=article)

Importance of EHR in accumulating data

According to Journal of Clinical Oncology on Boston, MA. Rapidly accumulating clinical

information can support cancer care and discovery. Future success depends on information
management, access, use, and reuse. Electronic health records (EHRs) are highlighted as a

critical component of evidence development and implementation, but to fully harness the

potential of EHRs, they need to be more than electronic renderings of the traditional paper

medical chart. Clinical informatics and structured accessible secure data captured through EHR

systems provide mechanisms through which EHRs can facilitate comparative effectiveness

research (CER). Use of large linked administrative databases to answer comparative questions is

an early version of informatics-enabled CER familiar to oncologists. An updated version of

informatics-enabled CER relies on EHR-derived structured data linked with supplemental

information to provide patient-level information that can be aggregated and analyzed to support

hypothesis generation, comparative assessment, and personalized care. As implementation of

EHRs continues to expand, electronic databases containing information collected via EHRs will

continuously aggregate; aggregating data enhanced with real-time analytics can provide point-of-

care evidence to oncologists, tailored to patient-level characteristics. The system learns when

clinical care informs research, and insights derived from research are reinvested in care.

Challenges must be overcome, including interoperability, standardization, access, and

development of real-time analytics.

(http://ascopubs.org/doi/abs/10.1200/JCO.2012.42.8011)

Using EHR to Improve Quality and Efficiciency

Electronic health record (EHR) systems enable hospitals to store and retrieve detailed patient

information to be used by health care providers, and sometimes patients, during a patients

hospitalization, over time, and across care settings. Embedded clinical decision support and other

tools have the potential to help clinicians provide safer, more effective care than is possible by

relying on memory and paper-based systems. In addition, EHRs can help hospitals monitor,
improve, and report data on health care quality and safety. The Centers for Medicare and

Medicaid Services (CMS) calls EHRs, the next step in continued progress of health care.1

According to Health Management Associates, despite the utility of electronic health records,

hospitals were initially slow to adopt them. A 2009 survey of American Hospital Association

(AHA) members found just 1.5 percent of hospitals had a comprehensive EHR system, meaning

that the system performed 24 specific functions and was used in all clinical units. Another 7.6

percent of hospitals had an EHR in use in at least one clinical unit.2 Hospital leaders cited startup

and maintenance costs as major barriers to adoption.

An examination of nine hospitals that recently implemented a comprehensive electronic health

record (EHR) system finds that clinical and administrative leaders built EHR adoption into their

strategic plans to integrate inpatient and outpatient care and provide a continuum of coordinated

services. Successful implementation depended on: strong leadership, full involvement of clinical

staff in design and implementation, mandatory staff training, and strict adherence to timeline and

budget. The EHR systems facilitate patient safety and quality improvement through: use of

checklists, alerts, and predictive tools; embedded clinical guidelines that promote standardized,

evidence-based practices; electronic prescribing and test-ordering that reduces errors and

redundancy; and discrete data fields that foster use of performance dashboards and compliance

reports. Faster, more accurate communication and streamlined processes have led to improved

patient flow, fewer duplicative tests, faster responses to patient inquiries, redeployment of

transcription and claims staff, more complete capture of charges, and federal incentive payments.

(www. commonwealthfund.org)
RELATED STUDIES

This section presents other related studies by the people who conducted studies similar to the

proponents that will also greatly help in the progress of the study.

LOCAL STUDIES

Manual Recording of Data

Data recording manually can have a lot of disadvantages. May it be using so many papers

piled up in an alphabetical system using filing cabinets, it really requires a lot of patience for the

medical secretaries, especially if there are a lot of patients in that certain day.

Pacio(2013) as stated in her study entitled Online Student Information System of

Benguet State University stated that Benguet State University (BSU) is still using a semi

computer based system and paperbased student information system. Staff finds it tedious in

searching and preparing reports on students information and also laborious due to repetition of

processes done in filling and updating of records. As main goals of the school to generate and

disseminate new knowledge and technologies that will promote sustainable resource

development and enrich the competent and effective services geared towards efficiency and

economy the current system is inconsistent with the asserted schools main goals.

The main objective of the study was to design and develop an Online Student Information

System of Benguet State University. The OSISBSU would be a new way of record management

and transaction processing that would achieve efficiency on processing student information. It

would be a great help to the administrative personnel, academic personnel, grantors or

stakeholders, parents and students in updating, retrieving and generating student data.
 Same as to what our study aims to achieve, it is also developing a new system using

technology to eliminate the use of papers and filing cabinets in the workplace.

Easy-to-use interface

It is also necessary for the system to have a user friendly interface. The use of the system would

be more utilized if the user would be familiar in using it. A system would not have its value if it

was not properly used.

As stated in the study conducted at Mapua Institute of Technology entitled Dental Records

System Using Synchronized Touch Screen Kiosk and Server PC with GSM Module,

Most of the dental clinics are using traditional ways of keeping their patients data, dental

procedures, prescriptions and medication papers manually. Each patient has all these information

written in small dental cards. In most cases, the patient normally comes back to the dentist for

another appointment, further updates in dental procedures or profile information forces clinics to

attach another card to the latter card, until it piles up. These cards are filed in the cabinets or

drawers. These may cause the files to crumple or lose attachments. The clinics secretary may

find the situation difficult to browse records when the patient calls for another appointment and

for the dentist to review the patients previous dental records. Some clinics were already

introduced to dental records program, however medical people find the software difficult to use

because the interface was complicated. Dentists still need to study the program or train staffs to

utilize its use, but some of them are not interested because it is not their field of work. The Valera

Family Dental Clinic is one of those clinics which has an existing dental records program but
they never use it because they complain that they cannot understand everything in the program,

and that it is not user friendly.

Our study also aims to provide the medical secretaries an easy-to-use interface so that

they could easily operate the system. The researchers would like to develop something that

would help the people who are not familiar with using the computer easier for them to learn how

to use it. Knowing that the age-group of the medical secretaries specifically the ones in our main

study which is UPHMC were not so fund of using technology.

Quality of care

According to a study published on 2013 entitled Patient Record System in Saint Lukes Medical

Center stated that some hospitals still use the manual method which is time and energy

consuming but why it is that only few hospitals in the Philippines, being a newly industrialized

country may have a factor on why implementing a PRMS is impossible. The possible reasons

could be insufficient funds, lack of technical expertise and computer skills and the lack of data

processing facilities. In addition, the resistance of medical practitioners and health professionals

generally to change from manual to electronic documentation may be a problem. Most health

administrators and information managers are used to the old system and have this fear that it may

take time to change or at least modify some behavior and attitudes. The reason for wanting to

change to an electronic system is important. Most health administrators and information

managers expect to move from a paper to paperless environment. This is a major step to help

health institutions and the environment at the same time. By having an electronic system,

practitioners could improve the accuracy and quality of data recorded in a health record, enhance

practitioners access to a patients record, enabling it to be shared at present and also for the
future use, it could also improve the quality of care because of health information that a patient

need can be immediately available all the time.

Efficiency

According to the study entitled AUTOMATED ELECTRONIC RECORDS MANAGEMENT

REPORT/PLAN, End users find it burdensome to manage their electronic records if that means

touching each file and making a separate recordkeeping decision about each one. Relying on

busy end users who are focused on achieving the agency mission leads to inconsistent capture of

electronic records. The time required for each human records management action also means that

manual processes will not scale up to manage the sheer volume of email, social media, and other

electronic records being created. Automated tools for managing electronic records could reduce

the recordkeeping burden on end users and lead to more consistent, scalable results, and

ultimately more accessible and usable agency information

FOREIGN STUDIES

Automated System

Using an automated recording system for patients can be of great help with the medical

secretaries. It could help make them more efficient and effective as an employee. A good system

should be able to quickly collect data and edit the results to be efficient. And it should be able to

attain its goal by providing the current information to appropriate users.

As mentioned in the study entitled An Automated System for Patient Record

Management, Generally Automation plays an important role in the global economy and in daily

experience. Engineers strive to combine automated devices with mathematical and organizational

tools to create complex systems for a rapidly expanding range of applications. The Patient
Information Management System (PIMS) is an automated system that is used to manage patient

information and its administration. It is meant to provide the Administration and Staff, with

information in real-time to make their work more interesting and less stressing.

Efficient and Accurate

As conclusion on the study of Records Management System for Mbarara Hospital, in this

information age, it is therefore essential that records management be done with the utmost

efficiency and accuracy. This is the point at which records management is integrated with

computer science in order to develop a computer based records management system. The

conclusion is that efficient and comprehensive records keeping is as good as guaranteed when

the art of record keeping is simulated and integrated into a computerized records management

system. Management system without records and neither can there be efficient record keeping

without a good records management system. Therefore, record keeping is the Systematic

procedure by which the records of an organization are created, captured, maintained, and

disposed of. This system also ensures their preservation for evidential purposes, accurate and

efficient updating, timely availability, and control of access to them only by authorized

personnel.

Low-cost System

Providing low-cost system could be of great help especially with hospitals or clinics that have a

little budget when it comes to upgrading their record management.

As what the study entitle E-Health Patient Record Management System, the goal of the project

was to create a system that would benefit health care workers and patients by providing a low

cost system that they would be happy to use. We believe we have done this and that our system
could be used in any health care setting. The main aims of the system were to have the ability to

create, view, and store patient records.

The significance of this study is for that the system developed illustrates how a web-based

healthcare system would greatly improve the working conditions of a hospital by creating a

better patient caring environment. The fact that we used Open Source tools cut down the

software costs tremendously and is important.

Software-based System

Its a big challenge for some hospital dealing with the records of every patient and how will they

be able to manage well the workflow inside the hospital. But with this Hospital Record

management system there will be no more trouble of handling records because its a software

based system that could easily provide the records of every patient from admitting of patient,

discharge, diagnosis and etc. Proper filing of patients medical records ensures accurate and easy

retrieval that lessens the waiting time of the patient at the hospital. This system simplifies

all management processes and this solves the problem that the hospital faced in the current

manual system.

While in the study conducted in National Institutes of Health (NIH) and IOM,

They have listed strengths that paper is the most widely used record keeping form. Given the

prevalence of paper patient records, the committee noted that support by practitioners for this

kind of record keeping should not be underestimated. Time and resource constraints did not

permit the committee to survey user attitudes toward paper records; however, committee

members identified at least five strengths of such records from the perspective of record users:
1. Paper records are familiar to users who consequently do not need to acquire new skills or

behaviors to use them.

2. Paper records are portable and can be carried to the point of care.

3. Once in hand, paper records do not experience downtime as computer systems do.

4. Paper records allow flexibility in recording data and are able to record "soft" (i.e.,

subjective) data easily.

5. Paper records can be browsed through and scanned (if they are not too large). This

feature allows users to organize data in various ways and to look for patterns or trends

that are not explicitly stated.