Description
Introduction
The rapid influx of Rohingya refugees with a diversity of pressing health needs presents a number of challenges for the existing Bangladeshi healthcare system. To address this challenge of emerging unmet health needs, health providers have historically operated without formal systems for maintaining patient records. This lack of access to medical records hinders opportunities to establish consistent access to quality healthcare and results in poor health outcomes. Previous research investigating the role of electronic health record (EHR) systems to support displaced populations demonstrates potential to improve patient outcomes by tracking disease markers, increasing provider adherence to treatment guidelines, and increasing patient adherence. Terre des hommes (Tdh) has started the implementation of EMR in a primary healthcare center (PHC) in Cox’s Bazar, Bangladesh, in 2022, for the provision of services to Rohingya refugees. By January 2023, the EMR system achieved an impressive 98% coverage, displaying successful integration of health records. In August 2023, an updated EMR system was launched, incorporating new requirements to enhance functionality. Tdh is now preparing to extend EMR rollout to another PHC located in the area. The main objective of this study was to assess the opportunities and challenges around successful rollout of EMR in a refugee camp.
Methods
The study employed a qualitative methodology, through semi-structured Focus Group Discussions (FGD), to comprehensively assess EMR implementation gathering various perspectives within the healthcare setting. Informed consent was obtained from 20 participants, comprising 5 in administrative and 15 in clinical roles. These participants represented diverse disciplines, including TRIAGE, Sexual and Reproductive Health, casualty and emergency department, Laboratory, In-Patient Department (IPD), clinical administration, and the stock management team.
Results
The study results derived from pre- and post-implementation interviews were categorized to provide comprehensive insights into the EMR integration. Pre-implementation data were grouped into four categories: 1) EMR Modules Understanding; 2) Design Process Engagement; 3) Data Completeness; 4) Workload Effect. Post-implementation interviews yielded six categories: 1) EMR Staff Ownership; 2) Workload Effect; 3) Feature completeness and functionality; 4) Interaction with technical support; 5) Lessons learned; 6) Data Quality. These categories facilitated a detailed analysis, allowing for an in-depth understanding of the impact of EMR implementation, ranging from data standardization and workload to user experience and technical support interactions. The study presents valuable insights into the effective implementation of EMR in primary health care settings for Rohingya context. It contributes to enhanced knowledge regarding gaps and opportunities around EMR adoption and distinguishes the utility of EMRs compared to manual methods. Identified barriers include insufficient technical support post-launch, healthcare professionals perceiving an increased workload with EMR, and a notable learning curve for staff acclimating to EMR usage.
Conclusion:
These findings underscore the challenges and opportunities associated with EMR integration, shedding light on critical factors influencing successful implementation in humanitarian response programming. As Tdh focuses on spearheading further expansion of EHR systems in other PHC’s across Cox Bazaar, the key objective is to utilize the insights generated from this study for more effective implementation.
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