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User-Centered: Enhancing acceptance of electronic health records

By Carla Marie L. Asis, Mia P. Rey

SUMMARY

Implementation of the Universal Health Care (UHC) Law of 2019 in the Philippines requires the adoption of interoperable electronic health records (EHRs). Understanding user acceptance of EHRs is crucial for their successful adoption and integration into the healthcare system, and for fully achieving universal health coverage. A study conducted by the Philippine Primary Care Studies (PPCS) revealed that there is high user acceptance of EHRs in various settings in the Philippines, with self-efficacy as the only factor significantly associated with intent-to-use. This finding highlights the importance of developing EHR systems with a focus on user needs and existing workflows. Policy implications and recommendations for EHR implementation are outlined in this policy brief.

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HEALTH INFORMATION SYSTEMS IN PRIMARY CARE

Health information systems (HIS) provide data that empowers decision-makers throughout the health system, from policymakers to frontline providers. This data (1) helps identify health issues, (2) inform evidence-based decisions on policy and resource allocation that are congruent with patient demographics and behavior, (3) and ultimately guide the system toward optimal performance.

The UHC Law , passed in the Philippines in 2019, aims to strengthen primary care with HIS as one of its key components. Its implementation requires multiple EHRs to be interoperable across service delivery networks, allowing centralized patient information to be available across multiple access points. This transition to a digital health system faces challenges, especially in rural and remote settings where resources and infrastructure are limited. Understanding user acceptance of EHRs is crucial for their successful adoption and integration into the healthcare system, and for fully achieving universal health coverage.

EHR ACCEPTANCE IN THE PHILIPPINES

The PPCS aimed to improve the country’s primary healthcare system by addressing fragmentation and implementing various interventions. One key intervention was piloting an EHR system in three diverse settings: urban, rural, and remote. Recognizing the challenges associated with EHR adoption, PPCS prioritized the needs of healthcare workers by providing technical support and ensuring the EHR was designed to seamlessly integrate with existing workflows and practices. This user-centered approach aimed to make the system both practical and user-friendly. A study was conducted to examine healthcare providers’ intent-to-use of an EHR in the three settings. It identified key factors influencing their willingness to adopt the system. The study revealed the following:

  • High user acceptance: Over 94% of healthcare workers in all settings reported their intention to use the EHR system in the near future.
  • Self-efficacy is key: Self-efficacy, the belief in one’s ability to successfully use the EHR, was the only factor significantly associated with intent-to-use.
  • User-centered approach: The study highlights the importance of developing EHR systems with a focus on user needs and existing workflows, rather than simply for policy monitoring.

ENHANCING USER ACCEPTANCE OF EHR

POLICY IMPLICATIONS RECOMMENDATIONS
●          Prioritize self-efficacy: Training programs and support systems should focus on enhancing users’ confidence in their ability to use the EHR. The government should invest in robust training programs and support systems that build healthcare workers’ self-efficacy in using EHRs.
●          Grassroots approach: Implementations should involve healthcare providers in the design and development process to ensure systems are user-friendly and meet their specific needs. Policymakers should prioritize user-centered design in EHR development, engaging healthcare providers in the process.

 

●          Sustained support: Providing ongoing technical support and resources is essential for maintaining user acceptance and facilitating system integration. Funding should be allocated for ongoing technical support and maintenance of EHR systems to ensure their long-term usability and sustainability.

 THE PATH FORWARD

There is high potential for EHR adoption in the Philippines, especially when self-efficacy is strengthened and a user-centered design is prioritized. By implementing the recommendations outlined above, the country can successfully transition to a digital health system that enhances efficiency, improves quality of care, and increases patient satisfaction.

 

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Citations

De Mesa RYH, Galingana CLT, Tan-Lim CSC, et al. Facing the digital frontier: exploring user acceptance of electronic health records in an urban, rural and remote setting in the Philippines. BMJ Open Quality 2024;13:e002621. doi:10.1136/ bmjoq-2023-002621

World Health Organization (2011). Monitoring the Building Blocks of Health Systems: A Handbook of Indicators and Their Measurement Strategies.