Regarding: “Management of Electronic Patient Record Systems in Primary Healthcare in a Finnish County”

Dear Editors:

In the article written in this journal by Mäkelä et al., ¹ it was mentioned that renewal initiatives in primary healthcare are highly dependent on the use of information management tools such as electronic medical records (EMRs). This technology has the potential to support information-sharing among team members, improve quality and continuity of care (especially chronic disease management), support planning and accountability activities, and offer decision-making support. However, uptake in developing countries like Iran has been relatively slow. Implementation of EMRs requires change management and guidance in practice settings, and this support has not traditionally been provided. In this initiative, the Ministry of Health disseminated some guidelines for applying EMRs in different levels of healthcare delivery. There is a long way forward in order to reach international standards in EMRs. Some pilot studies are being carried out in teaching hospitals, and findings and outcomes of these studies will be assessed so that future policy-making can use these data.

The consultation phase of these initiatives has strongly confirmed the need for a tool to support the implementation of EMRs. ² The existing Iranian resources on EMR adoption tend to focus on providing the knowledge, tools, templates, and methodologies to support “first-time” selection and implementation of EMRs. Change management resources, such as training, support, and tools for “people” and “processes,” have not been as well documented or have been underutilized if they exist. Those who have already invested also need help to move to the next level of effective EMR use, when, for example, they will use tools for clinical decision support or quality improvement. Various EMR resources currently exist. ³

References

1 Mäkelä K , Virjo I , Aho J , Kalliola P , Kurunmäki H , Uusitalo L , Valli M , Ylinen S . Management of electronic patient record systems in primary healthcare in a Finnish county. Telemed J E Health, 2010; 16:1017–1023. a-0 2 Elson RB , Connelly DP . Computerized patient records in primary care. Their role in mediating guideline-driven physician. Arch Fam Med, 1995; 4:698–705. a-1 3 Safdari R , Mohamadzadeh N . Continous care history: A new step in the area of electronic medical record. Faslnameh Madarek Pezeshki, 2008; 1:8–12. http://ihima.behdasht.gov.ir/uploads/279_983_NO1_W86_Moraghebat.pdf. 2011 August . a-2

Response to Fayaz‐Bakhsh and Asar

Kari Mäkelä, Irma Virjo, Juhani Aho, Pentti Kalliola, Harri Kurunmäki, Leena Uusitalo, Markku Valli, and Suvi Ylinen

Dear Editors:

We would like to thank Fayaz-Bakhsh and Asar for the comments made regarding the implementation of electronic medical records (EMRs). The adoption of EMRs typically impacts on the working practices of the organization and on the personnel using these systems. We certainly agree with the comment made by Fayaz-Bakhsh and Asar that adoption of EMRs requires change management. Change management can often benefit from the use of formalized support tools, and it is certainly true that more support and training is also needed for healthcare personnel. We feel that this applies to all healthcare organizations, irrespective of the country in question.

We would like to encourage all organizations that are either currently implementing EMRs or planning to do so in the future to use all possible support tools and methods to obtain the greatest benefits from EMRs. Centralized, well-coordinated, and integrated EMR implementation processes are more likely to increase the chances of success. However, we feel that a word of caution is warranted also: Some support tools are quite extensive and complex, which could in some cases result in making the support tool the focus of the change instead of the EMR. A good, clear understanding of the goals to be attained is needed; otherwise, there is a risk of being lost in “the fog of change.”