to analyze the scope and acceptance of emr among doctors in india

TO ANALYZE THE SCOPE AND ACCEPTANCE OF

ELECTRONIC MEDICAL RECORDS AMONG DOCTORS IN INDIA

A Project of Summer Training

Submitted in partial fulfillment of the

Requirements for the award of the

Post-Graduate Diploma in Business Management

Batch: 2009-11

SUBMITTED TO: SUBMITTED BY:

Dr. Sudhir Ranjan Dash Fozia Afreen

Professor and Project Guide (IMS) BM-09071 (IV Trimester)

INSTITUTE OF MANAGEMENT STUDIES

LAL QUAN, GHAZIABAD

1

TOPIC: TO ANALYZE THE SCOPE AND ACCEPTANCE

OF ELECTRONIC HEALTH RECORDS AMONG

DOCTORS IN INDIA

2

DECLARATION

I hereby declare that this submission is my own work and to the best of my

knowledge and belief, it contains no material previously published or written by

another person, nor material which to a substantial extent has been accepted for the

award of any other degree or diploma of the university or other institute of higher

learning except where due acknowledgement has been made.

Fozia Afreen (BM-09071)

Date:

3

CERTIFICATE

This is to certify that the Project entitled “The Scope and Acceptance of Electronic

Health Records among Doctors in India”, which is being submitted by Fozia

Afreen, a student of PGDM, IMS- Ghaziabad is a record of the candidates own work

carried by her under my supervision. The matter embodied in this report is original

and has not been submitted for the award of any other degree.

Project Guide:

Dr. Sudhir Ranjan Dash Date:

4

EXECUTIVE SUMMARY

As a part of PGDM Program, all the students have to undertake a project, which

should be duly approved by the faculty concern. I had the privilege of undertaking the

project on “The Scope and Acceptance of Electronic Health Records among Doctors

in India” in the organization “Religare Technova”.

The main aim of the project is to study the physician’s perception about Electronic

Medical Records and what benefits they desire from the same. For this purpose I

prepared a questionnaire and got them filled by physicians.

Based on the statistical analysis, we find that the awareness about EMR is very low in

homeopathic, ayurvedic doctors as well as therapist. On the other hand majority of the

allopathic doctors are aware of EMRs functions and benefits. It is also seen that

customers seek four major kinds of benefits from EMRs which are Time saving,

decision making, social and administrative benefits. It has also been found that

physicians in India are ready to welcome EMRs, but they also feel that its use should

not be mandated.

From the analysis of secondary research, it has been observed that inspite of being an

early adopter the extent of IT penetration in India is very low because of lack of

government initiatives. There are also many medico-legal complications involved

with the use of EMRs; Hence India needs a uniform law to avoid these complications.

5

ACKNOWLEDGEMENT

The success of any research study depends upon various factors among which the

proper guidance from the experts in the industry and faculty plays an important role. I

would like to take the opportunity to thank everybody who was involved with me and

helped to make this project a success.

I would like to thank our project guide Dr. S. R. Dash for helping me and carefully

guiding me during the course of the project. He was there for me every time I had

difficulties and I greatly appreciate the useful suggestions provided by him.

Next, I would like to thank Mr. Aakash Bindal for assigning me the project and for

his proper guidance and cooperation. Without his useful tips the project would have

been incomplete.

I would also like to thank Mr. Kapil Munjal, Mr. Rajan Goyal, Mr. Amit Arora

and Mr. Rashmikant Mohanty for their useful advice and expert guidance, which

helped me in completing this project successfully.

I am also indebted to all staff members of the company for their kind and friendly

attitude and immense cooperation.

And last but not the least, I would like to thanks my Parents, Friends and

Colleagues for their constant support and encouragement.

6

CONTENTS

Chapter Topic Page no.

Cover page 1

Title of project 2

Declaration 3

Certificate 4

Executive summary 5

Acknowledgement 6

Contents 7-8

List of tables and figures 9-10

1 INTRODUCTION 12-22

1.1) Company profile 12-15

1.2) Indian Healthcare Industry

15-17

1.3) SWOT Analysis of Healthcare Industry

18

1.4) Healthcare and IT 19

1.5) Electronic Health Records

20

1.6) Benefits of EHR 20-21

1.7) EHR acceptance 21-22

7

1.8) Medico-Legal aspects 22

2 OBJECTIVES OF THE STUDY

24

3 RESEARCH METHODOLOGY

26

4 LITERATURE REVIEW 28

5 DATA ANALYSIS 30-58

6 FINDINGS AND CONCLUSIONS

60-61

7 RECOMMENDATIONS 63

BIBLIOGRAPHY 65

ANNEXURE 67-89

8

LIST OF TABLES AND FIGURES

List of Tables:

List of Tables Page No

i) India’s Healthcare Indicator 16

ii) India’s growing middle class population

16

iii) Cost of key healthcare procedures in India and other countries.

17

1.1) Frequency table for Gender 30

1.2) Frequency table for Age 31

1.3) Frequency table for Area of Practice 32

1.4) Frequency table for Qualification 33

1.5) Frequency table for Years of Experience

34

1.6) Frequency table for Familiarity with EMR

35

2.1) Cross-tab between Gender and Familiarity with EMR

36

2.2) Cross-tab between Age and Familiarity with EMR

37

2.3(i) Cross-tab between Area of Practice and Familiarity with EMR

39

2.3(ii) Cross tab between Area and Familiarity with EMR

41

2.3(ii) A) Chi square test 42

2.3(ii) B) Contingency test 42

2.4(i) Cross-tab between Years of Experience and familiarity with EMR

44

2.4(ii) Years and Familiarity with EMR 46

2.4(ii) A) Chi square test 47

9

2.5) Cross-tab between Qualification and Familiarity with EMR

48

3.1) Table representing KMO and Bartlett’s test

49

3.2) Table representing Communalities 50

3.3) Table representing total variance explained and extracted factors

51

3.4) Table representing Component Matrix

52

3.5) Table representing Rotated Component Matrix

53

4.1) Table representing Physician attitudes and beliefs towards EMRs

55-56

4.2) Table representing importance of EMR functions

57-58

List of Figures:

List of Figures Page No

1.1) Pie chart representing frequency of Gender

30

1.2) Bar diagram representing frequency of Age

31

1.3) Bar diagram representing frequency of Area of Practice

32

1.4) Bar diagram representing frequency of Qualification

33

1.5) Bar diagram representing frequency of Years of Experience

34

1.6) Bar diagram representing frequency of Familiarity with EMR

35

10

CHAPTER 1

INTRODUCTION

11

1. INTRODUCTION

1.1. Company profile:

Name: Religare is a Latin word that translates as ‘to bind together’. This name has been chosen to reflect the integrated nature of the financial services the company offers.

Symbol- The Religare name is paired with the symbol of a four-leaf clover. Traditionally it is considered good fortune to find a four-leaf clover, as there is only one four –leaf clover for every 10,000 three-leaf clovers found.

For Religare each leaf of the clover has a special meaning. It is a symbol of Hope, Trust, Care, Good Fortune.

Vision: To build Religare as a globally trusted brand in the financial services domain and present it as the ‘Investment Gateway of India’.

Mission: Providing complete financial care driven by the core values of diligence and transparency.

Brand Essence: Core brand essence is Diligence and Religare is driven by ethical and dynamic processes for wealth creation.

Religare technova Ltd. is the holding company of the IT business of a large diversified Indian translational promoter group, with business interest in Financial Services, Healthcare, Wellness, Pharmaceuticals, Aviation and Travel. Other group entities include Religare Enterprises, Fortis HealthCare, Religare Wellness (Formerly Fortis HealthWorld), Super Religare Laboratories (Formerly SRL Ranbaxy) and Religare Voyages.

The offerings of the company is divided into Products and Services. The Religare Technova umbrella includes Religare Technova Global Solutions (formerly Asian CERC information Technology Ltd and Capital Market solutions Pvt Ltd.), a global leader in providing Enterprise Software Solutions to the Capital and Financial markets; Religare Technova It services Limited, which provides Enterprise IT Solutions and Religare Technova Business Intellect Ltd, which provides knowledge Management Solutions.

Currently with over 2000 employees and presence in over 10 countries, Religare Technova is poised to be a leader in the global IT space. Religare Technova focuses

12

on clients in key verticals such as Banking and Financial Services, Insurance, Capital Markets and Health Sciences (Healthcare and Pharmaceuticals)

Religare Groups:

Fortis Healthcare: Fortis Healthcare Ltd, established in 1996 was founded on the vision of creating an integrated healthcare delivery system. With 22 hospitals in India, including multispecialty and super specialty centres, the management is aggressively working toward taking this to a significant level in the next few years to provide quality healthcare facilities and services across the nation.

Religare: Religare is a global financial services group with a presence across Asia, Africa, Middle East, Europe and the Americas. The group offers a wide array of products and services ranging from insurance, asset management, broking and lending solutions to investment banking and wealth management. The group has also pioneered the concept of investment in alternative asset classes such as arts and films. With over 10,000 employees across multiple geographies, Religare serves a million clients including corporates and institutions, high net worth families and individuals, and retail investors.

Religare SRL Diagnostics: Super Religare Laboratories Ltd (formerly SRL Ranbaxy) with 11 years of inception has become the largest pathological laboratory network in South Asia. It started a revolution in diagnostic services in India by ushering the most specialized technologies, backed by innovation and diligence. The current footprint extends well beyond India in the Middle East and parts of Europe.

Religare Wellness: Religare Wellness Limited (formerly Fortis Healthworld) is one of the leading players in the wellness retail space with a footprint of 100 stores across India. The group envisages setting up a pan India world class retail network of wellness stores that would provide comprehensive solutions under one roof.

Religare Voyages: The group also operates in the domain of Integrated Air Charter and Travel, anchored under the holding company Religare Voyages Ltd. The Air Charter business is one of the largest in the non-scheduled space in the country with its own top-of-the-line fleet that comprises jets, helicopters and turbo props. The travel business is duty accredited for complete management of both in-bound and out-bound Domestic and International travel.

Religare Health

The latest venture of Religare technologies is into the Healthcare information service whose aim is enabling better healthcare through information.

Objectives:

To provide healthcare information at the right time and place, in the way users want it.

To reduce the information asymmetry in the healthcare ecosystem.

To bring together all stakeholders in healthcare, on a common platform

To offer transparent and powerful information exchange in the healthcare ecosystem.

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Features:

i. Search and Select

ii. Facilitates better healthcare

iii. Electronic health records for patients and healthcare service providers.

iv. Content on Disease, Drugs and Preventive Healthcare.

Benefits to healthcare Services

i. Opportunity to be present on Largest Healthcare Eco system in India

ii. Increases visibility and awareness on patient friendly platforms.

iii. A great tool for doctors and hospitals to regulate and schedule patient traffic

iv. Help towards achieving better diagnosis and treatment.

Board of Directors of Religare Technova

Mr. Sunil Godhwani: Chairman and Managing director of Religare enterprise.

Mr. Padam Bahl: Practicing chartered accountant and an income tax advisor.

Mr. Vikram Sahgal: Senior engineer with an experience of 27 years.

Dr. Preetinder Singh Joshi: Dr. Joshi, an eminent cardiologist, has 32 years of experience in medical profession in India and abroad.

Mr.Harpal Singh: Mr. Singh has a 26 years of experience in the corporate sector. He holds the position of senior advisor at Religare Enterprise.

Mr. Maninder Singh Grewal: Mr. Garewal, a veteran of IT industry, has an experience of 26 years and is the managing director of Religare Technova.

Mr. J. W. Balani: Mr.Balani is engaeged with the export and import of whit goods. He has more than 39 years of work experience.

Ms. Sunita Naidu: Ms.Naidu specializes in orthodontics and has a work experience of more than 15 years.

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Awards and recognition:

Recently Religare Technova has been honoured with the following prestigious awards:

Membership of the elite Microsoft Dynamics President’s Club 2008.

Star emerging SI Sales Award by Microsoft in 2008.

Mantel of Cisco Premier Certified Partner in India subcontinent.

1.2. India’s healthcare industry:

Talking about India, when it comes to healthcare there are two India: one that provides high quality middle care to middle class Indians and medical tourists and the other (in which the majority of the population lives) in which limited or no access to safe, quality care is available.

The Indian healthcare industry is seen to be growing at a rapid pace and is expected to become a US$280 billion industry by 2020.The Indian healthcare market was estimated at US$35 billion in 2007 and is expected to reach over US$ 70 billion by 2012 and US$145 billion by 2017.According to the investment commission of India healthcare sector has experienced phenomenal growth of 12 % per annum in the last four years. Rising income level and growing elderly population are all factors that are driving this growth. In addition, changing demographics, disease profiles and the shift from chronic to lifestyle diseases in the country has led to increased spending on healthcare delivery.

Even so, the vast majority of the country suffers from a poor standard of healthcare infrastructure, which has not kept up with the growing economy. Despite of having centre of excellence in healthcare in healthcare delivery, these facilities are limited and are inadequate in meeting the current healthcare demands. Nearly one million Indians die every year due to inadequate healthcare facilities and 700 million people have no access to specialist care and 80% of specialist lives in urban areas. In order to meet manpower shortages and reach world standards India would require investment of up to $20 billion over the next five years.

India has approximately 600,000 allopathic doctors registered to practice medicine. This number is however higher than the actual number practicing because it include doctors who have immigrated to other countries as well as doctors who have died. India license 18,000 new doctors a year. With a world average of 3.96 hospital beds per 1000 population India stands just a little over 0.7 hospital beds per 1000 population.

Despite of all theses drawbacks, healthcare in India is booming and is poised to become a pillar of the Indian economy over the next few decades.

The role of privatization has been crucial in the development of Indian health services. Besides providing 70% of hospitals and 40% of the hospital beds, the private sector has fully revamped the industry. Funds are more readily available,

15

infrastructure and technology have drastically improved, and political issues in public hospitals have ceased.

Medical tourism has succeeded by offering high quality services at third world prices. Dental tourism has gained an especially strong reputation. Growing at 25% a year, medical tourism will easily become a $2 billion industry by 2012.

India has been known for alternative medicine for over forty years, but traditional medicine is losing popularity. Ayurveda centers are thriving due to standardization and licensing. With an emphasis on rejuvenation and detoxification, Ayurveda is gaining popularity overseas as well. This along with yoga is earning India tourists and patients worldwide. The city of Kerala has become a destination for its high-end resorts that specialize in Ayurveda.

Table i: India’s Health Indicators

No. of Doctors 5,03.900

Hospitals 15,097

No of Beds 8,70161

No. of Medical colleges 162

No of Nurses 7,37,000

Source: IndianBusiness.com/ Healthcare Industry

Revolution in the Indian healthcare industry

The two important factors that has caused a revolution in the healthcare industry of India are:

Economic Factors:

Since healthcare is dependent on the people served, India’s huge population of a billion people represent a big opportunity.

The expanding middle class has more disposable income to spend. Hence they demand for better healthcare facilities.

Table ii:

Middle class %of entire population

1998-99 44.92

2001-2002 50.53

2009-10 62.95

Source: CRIS infac,

16

Today people are spending more on healthcare and preferring private services to government ones.

Hospitals in India are running at 80-90% occupancy. With the demanding for healthcare for exceeding supply,India's healthcare industry is expected to grow by around 15% a year for the next six years.

Hospitals in India conduct the latest surgeries at a very low cost. Medical tourism is also booming in India.

Cost of key Healthcare Procedures (Currency USD)

Procedure US Thailand India

Cardiac surgery 50,000 14,250 4,000

Bone marrow

transplant

62,500 62,500 30,000

Liver transport 500,000 75,500 45,000

Orthopaedic

surgery

16,000 6,900 4,500

Source: India Brand Foundation report, IBEF Research

Corporate entities entering the healthcare sector, introducing managerial practices and tools are showing a marked preference for professionals leading to the expansion of the hospital management education industry.

Government factors:

To encourage R&D government extended tax holiday to R&D companies. The benefit of full custom duty exemption for specific equipment is available for manufacturing activity to the extent of 25% of the previous year’s export turnover. This will help the research based companies.

All drugs and materials imported or produced domestically for clinical trials will be exempted from custom and excise duties. This will encourage foreign companies to produce drugs in India.

17

1.3. SWOT Analysis of Healthcare Industry of India:

Strength:

Expertise in reverse technology

Support at the state government level

Emergence of biotech parks

Incentives to develop business

Natural competitive advantages of language

Low cost and ever-expanding educated workforce

Weaknesses

The rising cost of healthcare delivery

Limited access to life saving drugs

Majority of private hospitals are expensive for normal middle class family

Government is responsible to improve primary healthcare infrastructure

Opportunities

Greater incentives for original drug discovery will create opportunities for Indian companies to develop new competencies through collaborative research and global alliances.

Big pharma and biotech companies to choose India as the preferred hub for their global R&D and manufacturing operations.

Threats

The increasing cost of drug discovery and development and the increasing time to market

Declining R&D productivity

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1.4. Healthcare and IT

When it comes to the use of IT in Healthcare, the Indian government positioned itself as one of the early adopters of healthcare IT among developing countries when it launched its “Development of Telemedicine Technology” project in 1997. In 2002, the Department of Information Technology established the committee for the Standardization of Digital information in order to facilitate the implementation of telemedicine systems. In 2003,the Department published a framework for “Information Technology Infrastructure for Health in India.” This framework is centered on the philosophy that “information is determined of health” and that “healthcare is one of the keys that can benefit from the use of IT.” The framework encompasses:

Inspite of being an early adopter, India is not completely utilizing the benefits of IT in healthcare. The key IT application that are being implemented in the private healthcare sector include hospital IS, PACS and telemedicine programs. So far there are no instances of EHRs that completely integrate clinical information. The use of EHR for reporting, modeling and improving clinical decision-making is not yet a priority.

Challenges:

Policy Absence of clear, coordinated government policy to promote HIT adoption

Government funding Almost non existent government funding for HIT has resulted in lack of HIT adoption in government health facilities and a lack of trained medical informatics professionals.

Computer literacy Low computer literacy among the government staff, and to a large extent in the private provider community

Infrastructure and coordination

Lack of supporting infrastructure and coordination between public and private sector

Legacy systems Except for a few privately owned large hospitals, most patient records are paper based and very difficult to convert to electronic format.

Standards Local HIT systems that do not adhere to standards for information representation and exchange. This could be further complicated because of the use of multiple local languages by patients and some health workers

Privacy Patient confidentiality is an open area. The Supreme Court of India has not addressed the specific right of privacy issue with respect to health information

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1.5. Electronic Health Record (EHR)

An electronic health record (EHR) is a collection of data and information gathered or generated to record clinical care rendered to an individual. It is a comprehensive, structured set of clinical, demographic, environmental, social and financial data and information in electronic form, documenting the healthcare given to an individual.

The primary purpose of the electronic health record is for the ongoing care of the patient. The EHR should incorporate all significant clinical and administrative information pertaining to a given patient, thereby rendering it sufficient to enable the attending clinician to provide effective continuing care and to determine the patient’s condition at any given time. All activities that physician perform with paper records should be capable of being carried out using electronic records. The EHR should also enable healthcare providers other than the attending clinician to review the patient and render his/her opinion or assume the patients care at any time.

The secondary purposes are research/historical, epidemiology/public health, statistics, education, peer review, utilization studies, quality assurance, legal document (used as evidence) and healthcare policy development.

1.6. Benefits of EHR

EHR enables sharing of patient information any place at any time.

It reduces cost by shortening billing cycles and other core administrative and clinical operations- including storage and copying cost of medical records.

Direct data entry by clinician and staff greatly reduces transcription cost.

Create higher quality documentation (auditable, legible and organized charts and records)

Improves the accuracy of coding at the appropriate level.

Minimize the issues of incorrect and conflicting drug prescription.

EMR system greatly aids clinicians in immediate patient treatment and in capturing key information’s.

More complete records help clinicians and staffs to avoid mistakes.

Research and decision support are key uses for patient related data.

Obstacles

Startup cost of implementing such a system is high

The user needs to have some technical knowledge to use the system effectively and efficiently.

Confidentiality and security issues associated with the use of EHR.

Portability of the equipment is an issue associated with the use of EHR.

20

Lack of standardized terminology, system architecture and indexing.

1.7. EHR acceptance

Many hospitals are maintaining electronic records locally. The scope of data captured however is limited to basic demographics, registration and billing. Larger hospitals that store clinical data electronically store discharge summaries with information on procedures, orders and investigation reports. Despite the system’s ability to also store detailed reports and clinical interpretation electronically, many hospitals do not use it. As a result, clinical follow-up is either very limited or not feasible. Industry analyst feel that the goal of hospitals in India is more to adopt the general concept of EHRs but that they are not utilizing all of its capabilities.

Adoption- National (Public sector)

Because of EHR implementation is not federally mandated, public sector hospitals have been slow to adopt EHRs.Although the first EHR implementation in public sector hospitals began in the late 1990s, few hospitals have implemented a system. Most EHR adoption occurs voluntarily in large tertiary level centers.

The ministry of health is turning its attention towards the lack of government policies for HER adoption. Based on the rate at which development in the domain are taking place, it is likely that publicly owned health sector will soon mandate for a quick widespread adoption of IT.

Adoption- National (Private sector)

Unlike the slow rate of EHR adoption in the public sector, privately owned hospitals are implementing them aggressively. They use their system to capture all relevant patient data, unlike public hospitals that tend to use only parts of the systems. Private hospitals maintain the data in a repository so that it can be readily available once a once a universal interoperable EHR initiative is mandated by the government.

EHR implementation at various hospitals in the private sector can be classified as follows:

Small hospitals (Upto 100 beds):

IT applications are virtually non-existent. Although some hospitals are using computers and customized simple IS for administrative work, they are not used for processing clinical information.

Medium hospitals (more than 500 beds):

This hospital has the fastest growing rate of IT adoption, but hospitals are still mainly adopting low cost quasi-HIS for billing, registration, pharmacy and other basic modules.

Tertiary hospitals (more than 500 beds):

Most of these hospitals already have HIS implementation in place. If not efforts are underway.

21

Super-specialty hospitals:

Some superspeciality hospitals are demanding specific EMR systems that have the functionality to provide clinical information such as vital signs and clinical images (radiographical and analytical).

India has not yet felt the pressing need nor it has addressed the drivers for the implementation of a uniform, interoperable, national EHR system. The country has not even clearly defined the stakeholders who would benefit from such a system.

1.8. Medico legal aspects of the usage of EHR

If the hospital or healthcare delivery organizations violate standard of care (through inadequate oversight of its staff physicians) by allowing EHR or other technology of its choice to be used in such a way to harm patients, it might become a subject of corporate negligence action. The case of vicarious liability occurs when there is a design or other type of flaw in the technology that causes harm to the patients even though the physicians or other caregivers who uses the technology committed no negligence.

The unauthorized access to patient’s private information results in the privacy violation. User negligence, misdirected information flow or intentional security breach by a third party etc. could be some of the reasons for this information leakage.

Medical liability actions may also arise from acts of commission, which breach the standard of care and result in injury and damages to patients. Physicians could also find themselves in trouble by failing to use diagnostic and treatment modalities suggested by the embedded best practice guidelines in certain types of EMR. Here there could be an act of omission contributing to patient injury.

Preventative measures:

Some of the preventative measures suggested in the course of medical liability are the selection of appropriate healthcare information system, proper training of staff to ensure efficient use of system, documenting all information with justification (whether or not care provided), and preventing any further alteration to this records without proper documentation etc.

22

CHAPTER 2

OBJECTIVES OF THE STUDY

23

2. OBJECTIVES

To study the extent of IT penetration in the healthcare industry of India.

To analyze the level of awareness of doctors towards Electronic Medical

Records.

To study the factors affecting the level of awareness of doctors towards the

usage of EMR.

To identify the major benefits the users will seek from an EMR system

To study the perception of doctors towards the usage of Electronic Medical

Records.

To study the various anticipated utilization of EMR and to study their

importance.

24

CHAPTER 3

RESEARCH METHODOLOGY

25

3. RESEARCH METHODOLOGY

3.1 Research Design

Type of Research: Exploratory and Descriptive Research

3.2 Sample Design

Sample Unit: The doctors from Aligarh (Uttar Pradesh) region, (which

included doctors of Aligarh medical college and hospital, dental college and

hospital, tibia college and hospital as well as the individual practitioners)

who belong to different areas of practice (allopathic, homeopathy, ayurvedic,

therapist and unani doctors)

Sample Size: 73 doctors from Aligarh gave response, out of 11 responses

were incomplete or erroneous so they were eliminated. Hence the final

sample size was 62.

Sampling Technique: Judgmental Sampling

Sampling Area: Aligarh

3.3 Data Collection

Sources

1. Primary Data: Data was collected through structured questionnaire over

email responses and direct interview.

2. Secondary Data: Available on Internet and journals.

Tools

The data was collected through email responses and personal interview.

3.4 Data Analysis

Statistical analysis

Techniques: Frequencies, Cross-tabs, Factor analysis and Mean

3.5 Limitations of Study

1.Getting response from a large number of doctors under time constraints was difficult. Hence small sample size was one the limitation for this study.

2.Involving doctors from different parts of the country could have given a more meaningful and accurate analysis. But this was not possible due to time constraints. This was another limitation of this study

26

CHAPTER 4

LITERATURE REVIEW

27

4. LITERATURE REVIEW

4.1 HIMSS Electronic Health records- A global perspective

This is an abstract from the work done by HIMSS Enterprise System Steering Committee and the Global Enterprise task force. This paper explains the extent of acceptance of Electronic Health Records by different countries of the world. It also analyses the scope of HER in different countries and the legal issues involved with it.

4.2 NBR centre for Health and Ageing (Health Information Technology and Policy Lab)

It is a case study on the extent of IT penetration in the Indian Healthcare Industry. It analyses the framework for information technology in India. This article throws light on the Government funding in the field of HIT and the role of the private sector in giving boost to HIT in India. It also analyses the future opportunities and obstacles in the field of HIT.

4.3 Healthcare informatics

Thursday, September 10, 2009

This article throws light on medico-legal aspects of using Electronic health Records and could be the possible preventive measures.

4.4 Emerging Market Report- Health in India 2008-09, PricewaterhouseCoopers

This article throws light on the opportunities in the healthcare sector in India. It traces

the growth in the healthcare sector over the past few years. It also compares the cost

of some of the major healthcare procedures in India with that of other developed and

developing countries. This article also throws light on the emergence and scope of

medical tourism in India

4.5 India HIT Case Study, Virk Pushwaz, Fellow, Harvard University

This case study throws light on the adoption of IT in the healthcare sector of India and

the government initiatives taken in this field. It also talks about the role of private

players in Indian Healthcare Industry in the promotion of the use of IT.

28

CHAPTER 5

DATA ANALYSIS

29

1. ANALYSIS BY FREQUENCY DISTRIBUTION

Table 1.1: Representing the frequency of gender

Gender

Frequency Percent

Valid Percent

Cumulative Percent

Valid Male 42 67.7 67.7 67.7

Female 20 32.3 32.3 100.0

Total 62 100.0 100.0

Fig. 1.1: Representing the frequency of gender

Analysis 1.1: The table shows that there were 42 males and 20 females out of 62 on whom the survey was conducted.

30

Table 1.2: Representing the frequency of age

Age

Frequency Percent

Valid Percent

Cumulative Percent

Valid 20-30 years

20 32.3 32.3 32.3

30-40 years

25 40.3 40.3 72.6

40-50 years

9 14.5 14.5 87.1

Above 50 years

8 12.9 12.9 100.0

Total 62 100.0 100.0

Fig. 1.2: Bar diagram representing the frequency of age

Analysis 1.2: The above table and figure shows that there were 20 doctors of the age group 20-30 years, 25 doctors of the age group 30-40 years, 9 doctors of the age group 40-50 years and 8 doctors of the age group 50 and above, out of 62 doctors on whom the survey was done.

31

Table 1.3: Representing frequency of area of practice

1. Area of practice:

Frequency Percent

Valid Percent

Cumulative Percent

Valid Allopathic 23 37.1 37.1 37.1

Dental 18 29.0 29.0 66.1

Homeopathy

3 4.8 4.8 71.0

Therapist 9 14.5 14.5 85.5

Others 9 14.5 14.5 100.0

Total 62 100.0 100.0

Fig. 1.3: Bar diagram representing the frequency of area of practice

Analysis 1.3: The above table and figure shows that there were 23 allopathic doctors, 18 dentist, 3 homeopathic doctors, 9 therapist and 9 doctors from others category (unani, ayurveda etc.), out of 62 doctors on whom the survey was conducted.

32

Table 1.4: Representing the frequency of qualification

2. Qualification

Frequency Percent

Valid Percent

Cumulative Percent

Valid Medical graduate

40 64.5 64.5 64.5

Specialist 18 29.0 29.0 93.5

Superspecialist

4 6.5 6.5 100.0

Total 62 100.0 100.0

Fig. 1.4: Bar diagram representing the frequency of qualification

Analysis 1.4: The above table and figure shows that there were 40 medical graduates, 18 specialists and 4 superspecialist, out of 62 doctors on whom the survey was done.

33

Table 1.5: Representing the frequency of years of experience

3. Years of experience

Frequency Percent

Valid Percent

Cumulative Percent

Valid 1-5 years 15 24.2 24.2 24.2

5-10 years

17 27.4 27.4 51.6

10-15 years

15 24.2 24.2 75.8

15-20 years

5 8.1 8.1 83.9

>20 years 10 16.1 16.1 100.0

Total 62 100.0 100.0

Fig. 1.5: Bar diagram representing the frequency of experience

Analysis 1.5: The above table and diagram shows that there were 15 doctors with experience of 1-5 years, 17 with experience of 5-10 years, 15 with experience of 10-15 years, 5 with experience of 15-20 years and 10 with experience of above 20 years, out of the 62 doctors on whom the survey was conducted.

34

Table 1.6: Representing the frequency of familiarity/non familiarity with EMR function and benefits.

4. Are you familiar with EMR function and benefits?

Frequency Percent

Valid Percent

Cumulative Percent

Valid Yes 47 75.8 75.8 75.8

No 15 24.2 24.2 100.0

Total 62 100.0 100.0

Fig. 1.6: Bar diagram representing the frequency of familiarity/non familiarity with EMR function and benefits.

Analysis 1.6: The above table and figure shows that 47 doctors said that they are familiar with EMR function and benefits and 15 doctors said that they are unfamiliar with EMR function and benefits, out of 62 doctors on whom the survey was conducted.

35

2. ANALYSIS BY CROSS -TAB

2.1) Gender and Familiarity with EMR

Table 2.1

Case Processing Summary

Cases

Valid Missing Total

N Percent N Percent N Percent

Gender * 4. Are you familiar with EMR function and benefits?

62 100.0% 0 .0% 62 100.0%

Gender * 4. Are you familiar with EMR function and benefits? Crosstabulation


1 2 Total

Gender 1 Count 32 10 42

% within Gender

76.2% 23.8% 100.0%

2 Count 15 5 20

% within Gender

75.0% 25.0% 100.0%

Total Count 47 15 62

% within Gender

75.8% 24.2% 100.0%

Analysis 2.1: The above crosstabulation shows that: -

out of 42 males, 32(76.2%) were familiar and 10(23.8%) were unfamiliar with EMR benefit and functions.

Out of 20 females, 15(75.0%)were familiar and 25(25.0%) were unfamiliar with EMR benefit and functions.

Inference: The familiarity of doctors towards the EMR benefit and functions is independent of gender.

36

2.2) Age and familiarity with EMR

Table 2.2


Cases

Valid Missing Total


Age * 4. Are you familiar with EMR function and benefits?

62 100.0% 0 .0% 62 100.0%

Age * 4. Are you familiar with EMR function and benefits? Crosstabulation

In years 4. Are you familiar with EMR function and benefits?

Yes No Total

Age 20-30 Count 15 5 20

% within Age

75.0% 25.0% 100.0%

30-40 Count 19 6 25

% within Age

76.0% 24.0% 100.0%

40-50 Count 7 2 9

% within Age

77.8% 22.2% 100.0%

Above 50

Count 6 2 8

% within Age

75.0% 25.0% 100.0%


% within Age

75.8% 24.2% 100.0%

37

Analysis 2.2: The above crosstabulation shows that:

1. In the 20-30 years age group, 15(75%) were familiar and 5(25.0%) were unfamiliar with EMR function and benefits.

2. In the age group 30-40 years, 19(76%) were familiar and 6(24%) were unfamiliar with EMR function and benefits.

3. In the age group 40-50 years, 7(77.8%) were familiar and 2(22.2%) were unfamiliar with EMR function and benefits

4. In the age group of above 50 years, 6(75%) were familiar and 2(25%) were unfamiliar with EMR function and benefits.

Inference: The above crosstabulation proves that age of doctors does not affect their familiarity level with EMR function and benefits.

38

2.3(i) Area of practice and familiarity with EMR

Table 2.3(i)


Cases

Valid Missing Total


1. Area of practice: * 4. Are you familiar with EMR function and benefits?

62 100.0% 0 .0% 62 100.0%

1. Area of practice: * 4. Are you familiar with EMR function and benefits? Crosstabulation

Count

4. Are you familiar with EMR function and

benefits?

Yes No Total

1. Area of practice:

Allopathic 22 1 23

Dental 16 2 18

Homeopathy

1 2 3

Therapist 4 5 9

Others 6 3 9

Total 47 15 62

39

Analysis 2.3(i): The above crosstabulation shows that:

Out of 23 allopathic doctors, 22(95.6%) are familiar and 1(4.3%) are unfamiliar with EMR function and benefits.

Out of 18 dental doctors, 16(88.8%) are familiar and 2(11.12%) are unfamiliar with EMR function and benefits.

Out of three homeopathy doctors, 1(33.3%) were familiar and 2(66.6%) were unfamiliar with EMR function and benefits.

Out of 9 therapists, 4(44.4%) were familiar and 5(55.5%) were unfamiliar with EMR function and benefits.

Out of 9 doctors in the others category (unani, ayurvedic doctors), 6(66.6%) were familiar and 3(33.3%) were unfamiliar with EMR function and benefits.

Inference: Area of practice influences the familiarity level of doctors with EMR function and benefits.

40

2.3(ii): For further validating the above inference, the five areas of practice is merged into a dichotomous variable and hypothesis testing is done.

Allopathic and dental doctors= 1

Homeopathy, therapist and others= 2

Table 2.3(ii)


Cases

Valid Missing Total


Area * 4. Are you familiar with EMR function and benefits?

62 100.0% 0 .0% 62 100.0%

Area1 * 4. Are you familiar with EMR function and benefits? Crosstabulation


1 2 Total

Area1 1 Count 38 3 41

% within Area1

92.7% 7.3% 100.0%

2 Count 9 12 21

% within Area1

42.9% 57.1% 100.0%


% within Area1

75.8% 24.2% 100.0%

41

Table 2.3(ii)-A

Chi-Square Tests

Value doAsymp. Sig.

(2-sided)Exact Sig. (2-sided)

Exact Sig. (1-sided)

Pearson Chi-Square 1.880E1 1 .000

Continuity Correctionb 16.180 1 .000

Likelihood Ratio 18.462 1 .000

Fisher's Exact Test .000 .000

Linear-by-Linear Association

18.495 1 .000

N of Valid Cases 62

a. 0 cells (.0%) have expected count less than 5. The minimum expected count is 5.08.

b. Computed only for a 2x2 table

Table 2.3(ii)-B

Symmetric Measures

ValueApprox.

Sig.

Nominal by Nominal

Contingency Coefficient

.482 .000

N of Valid Cases 62

Analysis 2.3(ii):

Ho: There is no significant association between the area of practice and familiarity with EMR

H1: There is significant association between the area of practice and familiarity with EMR

Analysis: Since p value (0.00) < 0.05, hence null hypothesis is rejected.

Alternate hypothesis is accepted. Hence there is association between the area of practice and familiarity.

Contingency coefficient value is 0.482, which shows the association is fairly strong.

Inference: Area of practice influences the familiarity with EMR but the association between the two variables is not very strong.

42

2.4(i) Years of experience and familiarity with EMR

Table 2.4(i)


Cases

Valid Missing Total


3. Years of experience * 4. Are you familiar with EMR function and benefits?

62 100.0% 0 .0% 62 100.0%

43

3. Years of experience * 4. Are you familiar with EMR function and benefits? Crosstabulation

In years 4. Are you familiar with EMR function and benefits?

Yes No Total

3. Years of experience

1-5 Count 12 3 15

% within 3. Years of experience

80.0% 20.0% 100.0%

5-10 Count 13 4 17


76.5% 23.5% 100.0%

10-15 Count 10 5 15


66.7% 33.3% 100.0%

15-20 Count 5 0 5


100.0% .0% 100.0%

>20 years Count 7 3 10


70.0% 30.0% 100.0%



75.8% 24.2% 100.0%

44

Analysis 2.4 (i): The above crosstabulation shows that:

3. Out of doctors with 1-5 years of experience, 12(80%) are familiar and 3(20%) unfamiliar with EMR.

4. Out of doctors with 5-10 years of experience, 13(76.5%) are familiar and 4(23.5%) were unfamiliar with EMR benefit and function.

5. Out of doctors with 10-15 years of experience, 10(66.7%) are familiar and 5(33.3%) are unfamiliar with EMR function and benefits.

6. Out of doctors with 15-20 years of experience, 5(100%) are familiar and 0(0.0%) are unfamiliar with EMR function and benefits.

7. Out of doctors with >20 years of experience, 7(70.0%) are familiar and 3(30%) are unfamiliar with EMR function and benefits.

Inference: The above crosstabulation shows that years of experience do not influence the familiarity level of doctors towards the function and benefits of EMR.

45

2.4. (ii) For further analysis the five groups in the years of experience has been converted into the dichotomous variableLess than and equal to 10 years= 1More than 10 years= 2

Table 2.4(ii)


Cases

Valid Missing Total


Years * 4. Are you familiar with EMR function and benefits?

62 100.0% 0 .0% 62 100.0%

Years * 4. Are you familiar with EMR function and benefits? Crosstabulation

Count


1 2 Total

Years 1 25 7 32

2 22 8 30

Total 47 15 62

46

Table 2.4(ii)-A

Chi-Square Tests

Value dfAsymp. Sig.

(2-sided)Exact Sig. (2-sided)

Exact Sig. (1-sided)

Pearson Chi-Square .194a 1 .660

Continuity Correctionb .021 1 .886

Likelihood Ratio .194 1 .660

Fisher's Exact Test .770 .442

Linear-by-Linear Association

.191 1 .662

N of Valid Cases 62

a. 0 cells (.0%) have expected count less than 5. The minimum expected count is 7.26.

b. Computed only for a 2x2 table

Analysis 2.4(ii):

Ho: There is no association between the years of experience and familiarity with

EMR function and benefits.

H1: There is association between the years of experience and familiarity with EMR

function and benefits.

Observation: The p value > 0.05, hence the null hypothesis is accepted.

Inference: There is no association between the years of experience of doctors and

familiarity with EMR function and benefits.

47

2.5) Qualification and familiarity with EMR function and benefits.

Table 2.5


Cases

Valid Missing Total


2. Qualification * 4. Are you familiar with EMR function and benefits?

62 100.0% 0 .0% 62 100.0%

2. Qualification * 4. Are you familiar with EMR function and benefits? Crosstabulation

Count


Yes No Total

2. Qualification

Medical graduate

29 11 40

Specialist 15 3 18

Superspecialist

3 1 4

Total 47 15 62

Analysis 2.5: The above crosstabulation shows that:

Out of 40 medical graduates, 29(72.5%) are familiar and out 11(27.5%) are

unfamiliar with EMR functions and benefits.

Out of 18 specialists, 15(83.3%) are familiar and 3(16.6%) are unfamiliar with


Out of 4 superspecialists, 3(75%) are familiar and 1(25%) are unfamiliar with


Inference: The familiarity of doctors with EMR is more or less similar in all the three

48

categories. Hence it can be inferred that qualification does not influence the

familiarity of doctors with EMR function and benefits.3) FACTOR ANALYSIS:

Table 3.1: Representing KMO and Bartlett’s test

KMO and Bartlett's Test

Kaiser-Meyer-Olkin Measure of Sampling Adequacy.

.550

Bartlett's Test of Sphericity

Approx. Chi-Square 80.532

df 36.000

Sig. .000

Analysis 3.1: KMO is an index used to examine the appropriateness of factor analysis. The value between 0.5 and 1.0 indicates that factor analysis is appropriate. Since KMO value is 0.550(which is greater than 0.50), hence factor analysis is appropriate.

49

Table 3.2: Representing Communalities

Communalities

Initial Extraction

6a. Display of clinical notes and reports.

1.000 .687

6b. Display of lab results.

1.000 .824

6c. Display of radiology images

1.000 .598

6d. Entry and Display of diagnosis and medications

1.000 .683

6e. Display of height, weight and allergies.

1.000 .806

6f. Prescription writing.

1.000 .719

6g. Decision support (Guidelines, expert logic, reminders/alerts)

1.000 .537

6h. Display of structured documentation.

1.000 .832

6i. Display of demographics.

1.000 .774

Extraction Method: Principal Component Analysis.

Analysis 3.2: Communality of each statement refers to the variance being shared or which is common by other statement also. With reference to the first statement, the extraction is 0.687 which indicates that 68.7% of the variance is being shared or common to other statements.

50

Table 3.3: Table showing the total variance explained and the extracted factors.

Total Variance Explained

Component

Initial EigenvaluesExtraction Sums of Squared Loadings

Rotation Sums of Squared Loadings

Total

% of Varianc

eCumulativ

e % Total

% of Varianc

eCumulativ

e % Total

% of Varianc

eCumulativ

e %

1 2.323

25.807 25.8072.32

325.807 25.807

1.828

20.314 20.314

2 1.806

20.071 45.8781.80

620.071 45.878

1.792

19.907 40.222

3 1.309

14.547 60.4251.30

914.547 60.425

1.439

15.991 56.213

4 1.021

11.348 71.7731.02

111.348 71.773

1.400

15.560 71.773

5 .730 8.112 79.885

6 .670 7.449 87.334

7 .488 5.427 92.761

8 .352 3.911 96.672

9 .299 3.328 100.000


Analysis 3.3: About 71.773% of total variance in the 9 variables is attributable to the first four components. Also we can judge how well the ten-component model describes the original variables, by examine the above table and concluded that Component 1 explains a variance of 1.826, which is 20.314 % of total variance of 9, Component 2 explains a variance of 1.792, which is 19.907% of total variance, Component 3 explains a variance of 1.1.439, which is 15.991% of total variance, Component 4 explains a variance of 1.400, which is 15.560% of total variance. The amount if variance by the four components is 6.459, which is 71.773% of the total variance in the 9 components. The rest five components together accounts for 28.227% of the total variance.

51

Table 3.4: Table representing Component Matrix

Component Matrixa

Component

1 2 3 4


-.612 .345 -.309 .313


-.529 .568 .317 .349


-.384 .594 -.291 .112


-.512 -.121 .567 -.293


.095 .569 -.399 -.559


.654 .237 .075 .479


.673 .070 .067 .273


.137 .509 .734 -.127


.592 .593 .000 -.265


a. 4 components extracted.

52

Table 3.5: Representing rotated component matrix

Rotated Component Matrixa

Component

1 2 3 4


-.171 .794 -.051 -.159


-.062 .745 -.151 .492


-.052 .717 .286 -.012


-.625 -.046 -.233 .486


-.085 .138 .882 -.045


.839 -.038 -.021 .116


.687 -.246 .022 .059


.124 -.005 .150 .891


.451 -.104 .691 .287

Extraction Method: Principal Component Analysis. Rotation Method: Varimax with Kaiser Normalization.

a. Rotation converged in 6 iterations.

53

Analysis 3.5: In table 3.5, factor 1 has high coefficient for variable 6 (Prescription

writing) and variable 7 (Decision support) and a negative coefficient for variable

(entry and display of diagnosis and medication is negatively related). Both

prescription writing and expert guidelines and alerts will help the physicians save

their time, hence Factor 1 can be termed as Time saving factor. Factor 2 has high

coefficient for variable 1 (display of clinical notes and reports), variable 2 display of

lab results and variable 3 (display of radiology images). Factor 2 will help the

physicians in decision making and will help reduce error. Hence factor 2 can be

termed as Decision making Factor. Factor 3 has high coefficient for variable 5

display of height, weight and allergies and variable 9 (display of demographics).

Factor 3 will help in keeping a record of the people of the area so that better

healthcare facilities can be provided to them in short time. This factor is related to the

society hence can be termed as Social factor. Factor 4 has high coefficient for

variable 8(display of structured documentation). This factor will help in

administrative works. Hence can be termed as Administrative Factor.

Further, it is observed that the first three factors are helpful in clinical works. Hence

it can together be termed as clinical factor. And the last factor is helpful in

administrative work. Hence it can be termed as administrative factor.

54

4. ANALYSIS BY MEAN

4.1) Physician attitudes and beliefs

Table 4.1

One-Sample Statistics

N MeanStd.

DeviationStd. Error

Mean

5a.EMR improves quality of care and reduces error

47 2.57 1.037 .151

5b.EMR improves quality of practice.

47 2.17 .892 .130

5c. EMR increases practice productivity.

47 1.83 .481 .070

5d. EMR usage should be mandated.]

47 2.81 1.076 .157

5e. Doctors will devote the time required for the EMR training ]

47 2.23 .598 .087

5f. EMR benefits outweigh the cost.]

47 2.43 .801 .117

55

Variables Mean % agreeing % disagreeing

a) EMR improves

quality of care and

reduces error

2.57 61.7 38.9

b) EMR improves

quality of practice

2.17 76.6 23.4

c) EMR increases

practice productivity

1.83 95.7 4.3

d) EMR usage should

be mandated

2.81 44.7 55.3

e) Doctors will

devote the time

required for the EMR

training

2.23 76.6 23.4

f) EMR benefits

outweigh the cost

2.43 51.1 48.9

Analysis 4.1Table 4.1 summarizes respondents general attitudes and beliefs regarding EMRs, including familiarity with function and benefits, impacts, usage/training and overall value and need for adoption. Both the mean rating for each item and percentages “agreeing” and “disagreeing” are presented. These percentages were calculated by collapsing a five point likert scale from (1) strongly agree to (2) strongly disagree to create a dichotomous variable, “agree” and “disagree”.

A majority (95.7%) of the respondent feels that EMR would increase practice productivity. 76.6% of the doctors feel that EMR will improve the quality of practice and the doctors will devote the time required for the EMR training.61.7% of the respondents feel that EMR will improve quality of care and will reduce error.Almost half of the respondents (51.1%) feel that EMR benefits outweigh the cost.Very less that is only 44.4% of the respondents feels that EMR usage should be

56

mandated.

2) Importance of EMR functions

Table 4.2

One-Sample Statistics

N MeanStd.

DeviationStd. Error

Mean


47 1.49 .547 .080


47 1.89 .667 .097


47 1.91 .717 .105


47 1.40 .614 .090


47 2.15 .551 .080


47 2.02 .794 .116


47 2.00 .466 .068


47 1.98 .489 .071


46 2.91 .985 .145

57

FUNCTION MEAN SCORE RANK

Entry and display of diagnosis and medication

1.40 1

Display of clinical notes and reports

1.49 2

Display of lab results 1.89 3

Display of radiology images

1.91 4

Display of structured documentation

1.98 5

Decision support (guidelines, expert logic, reminders/alerts)

2.00 6

Prescription writing 2.02 7

Display of height, weight and allergies

2.15 8

Display of demographics 2.91 9

Analysis 4.2

Table 4.2 summarizes the respondent’s perception regarding the importance of specific EMR functions. The respondents were presented a list of nine functions.

Respondents considered all of the nine functions to be atleast slightly important (mean=< 3.0). The mean response for the nine EMR functions ranged from 1.40 (very important to quite important) to 2.91 (important to slightly important)As noted in the above table, the entry and display of diagnosis and medication was of greatest importance to doctors. Display of demographics was rated as the least important function. Display of clinical notes and reports was rated second with a

58

mean of 1.49.Display of structured documentation, inspite of being a very useful function for hospitals and nursing homes, was rated fifth with a mean of 1.98.Decision support, prescription writing and display of height, weight and allergies was sixth, seventh and eighth with the mean of 2.00,2.02 and 2.15 respectively.

CHAPTER 6

FINDINGS AND CONCLUSION

59

FINDINGS:

From the study conducted it has been found that, inspite of being a very early

adaptor in the field of HIT, the total penetration of IT in the Indian healthcare

industry is still very low as compared to other industries.

IT has been observed that out of the total respondents, majority of the

physicians (75.8%) are familiar with EMR function and benefits and only 24.2

% said that they are unfamiliar with EMR function and benefits.

From the above study it has been observed that gender, age, years of experience

and qualification has no association with familiarity of doctors with EMR

function and benefits.

From the above study it has been observed that area of practice has a moderately

good association with familiarity of doctors with EMR. It has been further

observed that allopathic and dental doctors are more familiar with EMR

function and benefits as compared to homeopathic, therapist and other

practitioners.

From the above study it has been found that the majority of physician (95.7%)

agree with the statement that EMR will increase practice productivity, but on

the other hand the majority (55.3%) disagree with the statement that EMR

usage should be mandated.

From the above study it has been found that the clinical functions of EMR

(Entry and display of diagnosis and medication, display of clinical notes and

reports display of lab results and display of radiology images) were given

higher rating (ranked 1st, 2nd, 3rd and 4th respectively) by the physician in terms

of their importance. Whereas on the other hand display of structured

documentation and display of demographics were given comparatively lower

rating (ranked 5th and 9th respectively). The lower rating of prescription writing

60

is somewhat surprising, but it can be explained by the familiarity of physician

with and use of paper based writing of prescription. So they feel at ease with

this method and are reluctant in using the new method. Physicians also use

several abbreviations while writing a prescription and this consumes less time,

on the other hand they will not be able to use them while writing a prescription

with the help of a computer.

From the factor analysis it has been found that customer will seek four major

kinds of benefits from EMR: Time saving, Decision making benefits, Social

benefits and administrative benefits.

CONCLUSION

From the secondary research it can be concluded the extent of IT penetration in the

healthcare industry of India is very low because of lack of government initiatives.

There are also many medico-legal complications involved with the use of EMR, so

the government should take initiatives in framing a standard set of rules to avoid these

issues.

From the primary research it can be concluded that the awareness of EMR among

allopathic doctors and dentist is more as compared to other practitioners. It has also

been found that consumer will seek four major kinds of benefits from an EMR, which

are time saving benefit, decision-making benefit, social benefit and administrative

benefits. The first three can be clubbed together into clinical benefits and the last one

as administrative benefits Clinical benefits were rated higher in term of importance.

So the kind and need of the end user should be kept in mind while designing the EMR

system.

It has been found that the clinical functions of EMRs were ranked higher by

physicians as compared to administrative functions in terms of importance and

majority of physicians are ready to welcome the EMR system in India, but they feel

that its use should not be mandated.

61

CHAPTER 7

RECOMMENDATIONS

62

7. RECOMMENDATIONS:

Instead of mandating the use of EMR, the physician perception about EMR should be understood first. This will allow for the development of targeted education to demonstrate the advantage of EMRs and to further improve their perception. This will lead to widespread adoption and successful implementation of EMRs.

Instead of designing a standard system for all, the need of the end users should be identified and the EMRs should be customized as per their needs and requirements.

63

BIBLIOGRAPHY

64

BIBLIOGRAPHY

Emerging market report 2008, Healthcare in India, PriceWaterhouseCooper

Framework for Information Technology for Health in India, Department of IT, Ministry of communication and IT, May 2003.

Healthcare in India, Emerging market report 2007, pp. 1-26

HIMSS, August 2008, EHR- A Global Perspective, pp. 70-77

India HIT Case Study, NBR Centre for Health and Ageing, Pushwaz Virk, Sharib Khan, Vikram Kumar, pp.1-4

Malhotra Naresh K. “Marketing Research” Pearson Education 5th edition, pp.

454-635

The Telegraph, Opportunities in Indian Healthcare Industry, July 7, 2010

Web resources

http://en.wikipedia.org/wiki/Electronic_health_record

http://www.brighthub.com/health/technology/articles/7402.aspx


http://www.expresshealthcaremgmt.com/20030915/index.shtml

http://www.hhmglobal.com/

http://www.indianbusiness.com/health-care

http://www.medicexchange.com/

www. religaretechnova .com/

65

http://www.religaretechnova.com/

http://www.indianbusiness.com/health-care

http://www.hhmglobal.com/

http://www.expresshealthcaremgmt.com/20030915/index.shtml



http://en.wikipedia.org/wiki/Electronic_health_record

ANNEXURE

66

ANNEXURE

1. Questionnaire

2. Sample Forms

TO STUDY THE SCOPE AND ACCEPTANCE OF ELECTRONIC MEDICAL RECORDS (EMR) AMONG DOCTORS

Dear Respondent,

You are requested to fill the provided questionnaire regarding the scope and acceptance of Electronic Medical records.

Name:

Age:

a) 20-30 years b) 30-40 years

c) 40-50 years d) above 50 years

Gender:

a) Male b) Female

Q1) Area of practice:

a) Allopath b) Dental

c) Homeopathy d) Therapist

e) Others

67

Q2) Qualification

a) Medical graduate b) Specialist

c) Super specialist

Q3) Years of experience

a) 1-5 years b) 5-10 years

c) 10-15 years d) 15-20 years

e) >20 years

Q4) Are you familiar with EMR function and benefits?

a. Yes b. No

Q5) If yes to question 4, then rate following factors on a five -point scales.

Highly Agree 2.Agree 3Neutral. Disagree 5.Highly Disagree

(1) (2) (3) (4) (5)

a) EMR improves quality of care and

reduce error

b) EMR improves quality of practice

c) EMR increases practice productivity

(i.e., patients per day)

d) EMR usage should be mandated

e) Doctors will devote the time required for

the EMR training

68

f) EMR benefits outweigh the cost

Q6) Rate the following anticipated utilization of EMR on a five-point scale

1. Most important 2. Important 3. Neutral 4. Unimportant

5. Most unimportant

(1) (2) (3) (4) (5)

a) Display of clinical notes and reports

b) Display of lab results

c) Display of radiology images

d) Entry and Display of diagnosis and

medications

e) Display of height, weight and allergies.

f) Prescription writing

g) Decision support

(Guidelines, expert logic, reminders/alerts)

h) Display of structured documentation

i) Display of demographics

Thank you for your co-operation.

69

to analyze the scope and acceptance of emr among doctors in india

Education

title of project

frequency table

project guide ims bm

allopathic doctors

doctors inindia

ayurvedic doctors

healthcare industry1

ehr acceptance