Unit 1: My Research
Research Field:
Table of Contents
“Why is there little or
no EMR\EHR system present in developing countries?”
“Why would a country want
an EMR system?”
“Is there an EMR\EHR \
e-health system available for developing countries.”
Research Questions,
Design and Methodology
Social, Ethical,
Professional and Legal Considerations
Word Count: 2780
Introduction
In this report I will explore the use of electronic health
records in South Africa and the rest of Southern Africa. I will explore my
research questions which asks the questions:
“Why is there little or no EMR\EHR system present in
developing countries?”
“Why would a country want an EMR system?”
“Is there an EMR\EHR \ e-health system available for
developing countries.”
South Africa and other Southern African countries face many
challenges that many developed countries would fail to understand. In this
report I want to make these challenges clear, so I may present my own solution
or prototype if available. I have explored academic literature reports and
journals which I have read during my research and hope to tie it back to my own
research questions stated above. My exploration will look at the issues EMR\EHR\
e-Health systems face in Southern African countries, the constraints they find
as well as any social, ethical, professional, and legal considerations found. I
will show my method of research, approach to literature and the goals I hope to
accomplish with my research.
Project Description
The use of EMR (Electronic Medical Records) \ EHR
(Electronic Health Records) or Health began as early as the 1960s with a Mayo
Clinic in Rochester Minnesota being one of the first major health system to
adopt EHR. With the use of storing
patient records and results into digital formats the healthcare database has
expanded exponentially since then. With over 50 years of collecting patient
data and with the use of data science and machine learning today. We can help distinguish patterns in our
current healthcare and healthcare from the past. As humanity learns more and
more about how certain aspects of life can affect our health, we can use the
data stored from EHRs to effectively predict certain outcomes. Here is a figure
showing the use of an EMR system by general practitioners in France.
EMR systems have been used to supply better health care to patients and allow doctors to make better diagnosis of their patients. Developed countries have now had the additional advantage of collecting long term data to help the developed country make correct decisions on healthcare using what people term big data in healthcare. As big data has changed the way we manage and analyze data across industries. Big data does not fit into the typical data processing format. It is a massive amount of data sets which cannot be stored, processed, or analyzed using traditional tools(Batko and Ślęzak, 2022). Big data in healthcare will continuously allow for greater medical research like machine learnt medical predictions could be implemented.
With such advantageous systems used in developed countries
why are developing countries lagging with little or no presence of EMR or EHR
systems present in their countries? I will use already written academic reports
and articles that discuss and explain the issues developing countries face when
implementing a EMR system. These issues could range from computer science
issues to corruption. In this report I will hope to find the problems faced
through these reports and articles and hope to give my own solution on how to
solve the problems faced in Southern African countries based on my research
done.
Preliminary Literature Review
“Why is
there little or no EMR\EHR system present in developing countries?”
A countries performance in healthcare can be mostly affected
by its economic growth and the invested resources. If for instance these two
key principles are inadequate, then this will result in a poor health system in
that country. On the other side of the coin a proper running healthcare
(greater healthcare expenditure) can lead to increase economic performance in a
country this was found to be true in the findings of Raghupathi and Raghupathi (2020). However, many difficulties
face with regards to a countries health care system is that of poor public
expenditure on health care. Sub Sharan countries could see a range of 0.6% to 1.5%
of the GDP being used for healthcare (Wootton, 2001). Where South Africa shows a decrease trend in
healthcare spending increased by 14.9% in 2016 and then a decrease of 3.16% in 2018.
This brings the healthcare GDP expenditure to 9.11% in 2019 (Macrotrends).
A review on telemedicine for developing countries brought up
some issues regarding the generic infrastructure of Sub- Saharan Africa. Where
poor electricity supply; poor-quality water supplies; isolation and lack of
continuing medical education are some generic infrastructures issues developing
countries have that are not the same as that found in developed countries. With
quality electricity supplies where the average consumption per capita is 124KWh
per year in Sub Sharan Africa, which is one tenth of what is found in
developing countries. This is not enough to power one light bulb for three
hours per person in Sub Saharan Africa. With an issue on infrastructure especially
that of power the EMR system should have the ability to be used using other
means such as batteries and generators where needed. The researchers used a
method of taxonomy on the projects and then focused on design issues developers
would face. These issues were taken from researched literature as well as
direct experience gained from working in the field. These design issues were
then classified and then allowed the researchers to bridge the gap between the
literature and the technical and practical needs to face when designing the
system(Combi et al., 2016). Their research founded that maintenance cost is
much higher after the system is implemented than that of the same system in a
developed country. Other issues found were that of no minimal required ICT
infrastructure for internet connections, bandwidth, etc. in most rural areas.
This lack of minimal required ICT infrastructure is one of the reasons why such
systems fail in Southern Africa.
What of a mobile system that uses mobile technology to
capture and run the EMR system. Would this possible in to implement in
developing countries? A mobile system would use mobile technologies to assist
in creating a EMR system. The rate of people in developing countries having access to mobile phones has
grown considerably to that of the population in the last 15 years (Union, 2013).
See figure below.
(Figure 1)
Figure 1.
Creating
a system which uses mobile technology will indeed help with issues of remote
connectivity to rural settlements in and around Southern Africa. However. It is
unfortunately it is not that simple to use mobile technologies as we run into
the problem of cost. Southern Africa has some of the highest costs for data in
the world. With most of the countries ranking higher than 170 in the Global broadband
pricing league table 2022 data (cable.co.uk, 2022). With extreme data prices in a developing country,
it will become difficult to instate a EMR system that works using purely mobile
technologies. This is due to the added costs that would come to hospitals and
doctors who would use the system. It is only through government intervention
that could see mobile technology work for an EMR system. Possibilities would
entail the government forcing free data billing while using the system on the
mobile providers in Southern Africa. Which could lead to many other political
reasons for this not being possible due to other forces like corruption and
poor governance. Karageorgos et al. (2019) founded that due to many
studies being conducted through pilot and/or small-scale trials does hinder any
significant conclusions to be drawn. However, there are positive signs that
mobile technologies could be used in developing countries as it has been shown health
workers benefit from such technologies(Combi et al., 2016).
In the paper Mandirola Brieux et al. (2015)
they researched through a survey how the impact of a eHealth implementation is
different in a developed and a developing country. They survived experts to
discover the expert’s opinion about five general questions. These questions
were: economic support by Government for eHealth, Government education or
training projects in the field, issues related to cultural or educational
problems for the implementation of eHealth, policies in terminology or
messaging standards and eHealth status policies for long periods. They found
there was a huge gap in cultural and education issues regarding eHealth. This
brings a issue that could be faced in Southern Africa which is that of
continuous education and cultural issues. Southern Africa is a culture which
area with many different cultures residing within it. Take South Africa for
example with 11 official languages each of which stems from a different culture
resining within the country.
Other concerns that could come in the way of a EMR system in
Southern Africa are that of legal and regulatory concerns. Is there commercial
gain at other party’s expense. What of individual consent vs group consent.
Another big concern for data in all parts of the world is the ownership of that
data. Who owns the data?
“Why would a
country want an EMR system?”
A journal of big data by Batko and Ślęzak (2022) describe what Big Data is and
how Big Data analytics has become and the possibilities that can come from Big
Data Analytics in healthcare. This journal gives a very well defined definition
of what Big Data is and what Big Data Analytics would entail. The paper first studies
literature and reviews studies on Big Data and Big Data Analytics, then it
presents results aimed at using big data analyses in medical facilities in
Poland. Poland is still considered a developing country which should help in my
research as like most Southern African Countries are developing countries. This
study concludes that Polish medical facilities use Big Data in healthcare to
benefit themselves in terms of business and administration goals. While they
are now progressing to use it for its patient healthcare benefits. It shows
that decisions made by medical facilities were largely data driven. Example new
purchases and restocking the facilities. This brings a form of governance to a medical
facility which could be seen as a desirable goal for facilities in Southern
Africa.
“Is there an
EMR\EHR \ e-health system available for developing countries.”
For this question I will take current products available in
South Africa and create a table of checkmarks to see if these products can
withstand the issues that developing countries face. This will be in terms of literature
review carried out and any correlations found between the research and churn
model created using unsubscribed users from systems. These product names will
remain anonymous for legal considerations. But will allow a clear answer for my
research question and hypothesis which is “There is no current EMR\EHR\ e-health
system which can be successfully hinder the issues faced in developing
countries in Southern Africa”.
Research Questions, Design and Methodology
My research
question for this research are as follows:
“Why is there little or no EMR\EHR
system present in developing countries?”
“Why would a country want an EMR
system?”
I hope these questions allow for a broad yet concise answer.
My hypothesis is that there is no exact answer to either of these questions.
Yet there will be similarities or hopeful prospects that could be found. The
design of this research will be to read through literature to find proof and
other findings to answer my research questions.
My intended approach will be a qualitive, interpretive
approach. Where the data will be collected systematically through review. With
the end goal to review existing articles regarding EMR\EHR or e-health development
in developing countries like Southern\Sub Sahara Africa, including that of
South Africa. I will then hopefully be able to create a churn model to find
correlation between events and cancelation of services of EMR\EHR\ e-Health
programs. I any correlation is found look for review literature which
specifically looks at those correlations or issues. With all literature and
churn model classification complete I will hope to create a design for a system
which will allow EMR\EHR e-health systems to prosper in developing countries
which hold similar issues found in Southern Africa. See below image for process
flow.
I plan to follow the guidelines of the hermeneutic framework, which was
developed based on the hermeneutic principle as discussed in Cochrane
Collaboration(Katurura and Cilliers, 2018).
I have chosen this framework as it seems to be most suitable for conducting a
qualitive research of data and describes the literature review process as fundamentally
a process of developing understanding that is iterative in nature(Boell and Cecez-Kecmanovic, 2014).
Resources and Constraints
With issue on resources, about many Southern African
countries in terms of clear statistics and clear legislation. I will try keep
my resources and descriptions as close to home (South Africa) as much as
possible. This is because I have had multiple years of experience in the field
of consulting and developing roll outs for EMR systems in South Africa. A lot
of constraints come from the POPI (Protection of Personal Information Act) legislation
in South Africa. This has given my research some hurdles to climb when asking
for data from a past company I used to work for regarding their data on
customers leaving. I was hoping to do a churn model to find similarities or
correlation to my research and the data which explains why people have unsubscribed
from the companies EMR system products.
If there is an issue with getting the dataset needed I will
try to conduct different research methods to gather information that correlates
to my hypothesis of no such EMR\EHR e-health system is currently available for
developing countries. As the current systems do not consider developing
countries issues in development.
Social, Ethical, Professional and Legal
Considerations
The World Health Organization (WHO) founded the Global
Observatory for e-health (GOe) in 2005. This was to have the WHO commit to
investigate and study the implementations of e-health (World-Health-Organisation). This allows for a better a
more transparent view of how e-health system should be implemented. The
considerations that come with EMR\EHR and e-health systems comes from many
sectors.
Another consideration comes from my current literature
review where educations and cultural issues are an important part of a
successful EMR system being implemented and maintained in developing countries.
This was expressed in multiple papers that I have read so far. This show it is
a clear concern and issue developing countries face when implementing EMR\EHR\
and e-health systems.
With South Africa planning to implement the National Health
Insurance scheme soon there are many legal considerations to consider when
developing a system. One of which is the legal considerations. In South Africa
the POPI act is one such consideration that will need to be checked. This act
protects the people of South Africa from miss use or unproper governance of
their personal information.
References
BATKO, K. & ŚLĘZAK, A. 2022. The use of
Big Data Analytics in healthcare. Journal
of Big Data, 9, 3.
BOELL, S. & CECEZ-KECMANOVIC, D.
2014. A Hermeneutic Approach for Conducting Literature Reviews and Literature
Searches. Communications of the
Association for Information Systems, 32,
257-286.
CABLE.CO.UK 2022. Global broadband
pricing league table 2022.
COMBI, C., POZZANI, G. & POZZI, G.
2016. Telemedicine for Developing Countries. A Survey and Some Design Issues. Appl Clin Inform, 7, 1025-1050.
KARAGEORGOS, G., ANDREADIS, I.,
PSYCHAS, K., MOURKOUSIS, G., KIOURTI, A., LAZZI, G. & NIKITA, K. S. 2019.
The Promise of Mobile Technologies for the Health Care System in the Developing
World: A Systematic Review. IEEE Rev
Biomed Eng, 12, 100-122.
KATURURA, M. C. & CILLIERS, L.
2018. Electronic health record system in the public health care sector of South
Africa: A systematic literature review. Afr
J Prim Health Care Fam Med, 10,
e1-e8.
MACROTRENDS, L. South Africa Healthcare Spending 2000-2022 [Online]. Available: https://www.macrotrends.net/countries/ZAF/south-africa/healthcare-spending
[Accessed 2022].
MANDIROLA BRIEUX, H. F., BHUIYAN MASUD,
J. H., KUMAR MEHER, S., KUMAR, V., PORTILLA, F., INDARTE, S., LUNA, D., OTERO,
C., OTERO, P. & BERNALDO DE QUIRÓS, F. G. 2015. Challenges and Hurdles of
eHealth Implementation in Developing Countries. Stud Health Technol Inform, 216,
434-7.
RAGHUPATHI, V. & RAGHUPATHI, W.
2020. Healthcare Expenditure and Economic Performance: Insights From the United
States Data. Front Public Health, 8, 156.
UNION, I. T. 2013. ICT Facts and
Figures.
WOOTTON, R. 2001. Telemedicine and
developing countries--successful implementation will require a shared approach.
J Telemed Telecare, 7 Suppl 1, 1-6.
WORLD-HEALTH-ORGANISATION.
Global Observatory for eHealth [Online].
Available: https://www.who.int/observatories/global-observatory-for-ehealth
[Accessed 2022].
Comments
Post a Comment