An Updated Case Study: Successful Implementation of an Electronic Medical Record System at BTFCC in Nepal

Background

The transition from a hybrid electronic-paper medical record system to an integrated Electronic Medical Record (EMR) system can significantly transform patient care and operational efficiency. However, such a transition often presents challenges, especially in regions with limited technology exposure. This case study focuses on the successful implementation of an EMR system at the BTFCC in Madhesh Province, Nepal.

Methods

A multidisciplinary committee was formed to oversee the EMR’s implementation. This committee customized the EMR system to meet BTFCC’s unique needs, and established staff training sessions. Post-launch, a rigorous audit system was put in place. Regression analyses were conducted to examine the association between time and improvement in documentation of different parts of the study.

Results

Initial resistance due to unfamiliarity with comprehensive EMR systems emerged as a significant challenge. However, following updates to the medical record policy and setting clear expectations for staff, audit reports showed substantial improvement in documentation from September 2022 to August 2023. Notably, documentation of the History of Present Illness (HPI) increased from 26.5% to 82.5%, and physical examination documentation improved by 80%. Moreover, regression analyses revealed a significant positive association between time and improvements in Examination documentation (β = 0.0501, SE = 0.0216, p = 0.043) and Plan documentation (β = 0.0342, SE = 0.0147, p = 0.043). HPI and Follow-up did not show significant improvement (p = 0.242 and p = 0.163, respectively). Assessment showed a positive trend (β = 0.0384, SE = 0.0191, p = 0.072).

Conclusion

A structured, stepwise approach and robust audit system are crucial for a successful transition to an EMR system. This pioneering implementation in Nepal demonstrates that such an approach can significantly enhance EMR adaptability and usage, leading to improved patient care, increased operational efficiency, and potential cost savings in regions with limited exposure to such technology.