Lessons learned in planning and preparing for implementation of an electronic medical records system in a reconstructive surgery project in Amman, Jordan
*Muhima Mohamed1, Abhinav Peddada2, Rasheed Al Sammaraie1, Marc Schakal1, Megan McGuire3
1Médecins Sans Frontières (MSF), Amman, Jordan; 2Thoughtworks®, 3MSF, New York, NY, USA
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Introduction
The Amman Reconstructive Surgery Program (RSP), a 148-bed hospital, has provided multidisciplinary clinical care to victims of conflict in surrounding countries since 2006. Multiple spreadsheets and forms were used to manage administrative and medical activities. MSF considered introducing an electronic medical record (EMR) system, with the objective of streamlining patient information flow and providing real-time feedback on care delivery and management. Lessons learned from pre-implementation and the initial phase of implementing an EMR are described with a focus on project governance, content development, and change management.
Methods
After market analysis and a site needs assessment in May 2016, the hospital team, in collaboration with a technology company (Thoughtworks), commenced planning for implemention of an open-source EMR. Pre-implementation involved creation of a governance structure at RSP to direct the project and streamline hospital processes. The initial implementation phase, which focused on developing a centralised platform, was completed in November, 2016. This involved registering candidate patients into the application and creating unique identifiers for each patient. The remaining phases of the implementation will include developing medical content and increasing visbility of patient data and patient flow. The implementation process is being managed by a dedicated project manager with support from Thoughtworks and the hospital team.
Ethics
This description/evaluation of an innovation project did not involve human participants or their data; the MSF Ethics Framework for Innovation (or equivalent) was applied to help identify and mitigate potential harms.
Results
The assessment identified several issues to be addressed: complex, duplicated, and person-dependent data collection; limited ability to share information; unreliable IT infrastructure; patients followed using multiple identifiers; no global view of patient flow; and a lack of standard terminology and definitions. RSP decided to invest in upgrading infrastructure, developing standardised terminology, and content creation.The main outcome of the initial implementation phase was the use of a unique and structured identifier for patients. Lessons learned include the importance of: leadership support throughout the implementation; training staff on the use of standard terminology and on the EMR; support for culture and process changes within the hospital; and a constant iteration process to provide quick turnaround for feedback provided by the hospital team in the devleopment of the EMR.
Conclusion
Implementation of the EMR is ongoing. Subsequent phases addressing patient flow and medical data are to be completed by mid-2017. So far, the project has sparked broad engagement by the hospital. Our findings show that in RSP, implementation should focus on how activities, patient flow, and information exchange are managed rather than on the technology.
Conflicts of interest
Abhinav Peddada is currently working as a consultant from Thoughtworks.