This blog post was written by Manjinder Sandhu and Elizabeth Young
Electronic health records (EHRs) can produce invaluable data to inform health care decisions and national and regional health planning. Coupled with advances in digital connectivity, EHRs have the potential to revolutionise health care—providing a framework for disease surveillance and response to epidemics, assessing therapeutic strategies, and informing health resource allocation.
EHRs are longitudinal electronic medical records, which are securely stored and shared, and can be accessed by multiple authorised users. The successful introduction of an EHR system depends on consistent electronic data entry at the point of care by clinical staff, supported by skilled information technology professionals. This creates a rich, robust, life-long health record which—if accessible at health interfaces—can improve patient care, as well as making it safer and more efficient.
Many low- and middle-income countries (LMICs) are facing a double burden of disease: an increase in non-communicable diseases on top of an existing high prevalence of infectious diseases. Likewise, the number of individuals living with multiple co-morbidities, requiring long-term management, is rising. Thus, stretched and often under-resourced health care systems are facing increasing demands and rising costs. In this context, EHRs could offer a more efficient way to support health care provision and planning in LMICs.
EHR implementation coupled with regional digital networks can: 1) enhance access to medical information—providing a mechanism to centralise or regionalise specialist clinical decision-making; 2) reduce clinical errors, such as clinical warnings to inform prescribing; 3) facilitate the management of a range of diseases and interpretation of clinical and biochemical results; and 4) provide a mechanism for clinical reminders for disease screening and follow-up. For clinical staff, dealing with large volumes of patients with multiple complex morbidities, such support and efficiency could substantially improve patient outcomes.
For governments, EHR systems can provide routine data collection for enhanced disease surveillance and enable accurate evaluation of health care providers and staff. Continuous processing of EHR data has the potential to provide near-real time information which can expedite outbreak detection and disease surveillance. These frameworks could provide an invaluable platform for clinical observational and interventional research. Likewise, capture of prescription and diagnostic trends can support pharmacovigilence and antibiotic stewardship activities. For health system planning, EHRs can facilitate assessment of health service coverage, efficiency and quality, assisting evidence-based decision-making for resource allocation.
Although implementing EHRs is a substantial undertaking, there is evidence of successful EHR implementation. However, few studies have evaluated the cost-effectiveness of EHRs at the national level, even in high-income countries with wide implementation. Evaluations that do exist have focused on smaller implementation programmes such as primary care settings or hospital sub-specialiaties, or have used modelling approaches. Importantly, for any EHR development programme, it will be essential to carefully define an evaluation framework that assesses both the success of implementation and the subsequent improvements in patient care. These steps will help capture the full potential of EHRs to facilitate and improve health care and health research in a global context.
Studies suggest that, whilst successful implementation of EHRs requires high upfront costs for the installation of EHR infrastructure and staff training, the return on such investment may be substantial in the long-term. Indeed, building digital frameworks for a national EHR system, including large-scale computational infrastructure, could also empower local government, academic, and research institutions, as well as accelerate and facilitate a range of commercial sectors, including high-performance computing, cloud infrastructure, and the pharmaceutical and biotechnology industries. Innovation through public-private partnership models could also reduce costs for implementation and management of EHRs. These approaches could provide the foundation for a digital future for LMICS.