Performance Risk

Implementing electronic health records at any facility requires a minimum requirement on the ground
needed for the smooth running and sustainability of the system. For example, having a shared health
record requires standard ICT infrastructure, skilled workforce, finance, leadership and governance etc.
Capabilities that support safe, efficient, effective and patient centered medical practices are given the
highest priority for an EHR system to fulfill. Thus, below are risks we think the system could face that
would hinder its performance and utilization.

A. Demographic and Health information - Refers to individual patient or client related information
regarding their demographic and health information generated and captured during health facility
encounters or visits. The information gathering is vital for the efficient performance of the EMR
system it enables health care providers to diagnose and treat illness and injuries.
Risk – Failure to complete demographic and health information for patients visiting health facilities,
which leads to poor & incomplete data of patients that care providers can use to diagnose and treat
illness and injuries.

Mitigations - The system will be able to capture demographic and clinical data using structured formats
and free texts, making it simple and easy to use. The system will incorporate chief complaints, problem
lists (including diagnoses), medication, lab test, procedures and data’s using selected & adopted
terminology standards.

B. Referral management - Care providers using the E H R system shall be able to order clinical
investigations, procedures, cares and other services within or to other health facilities electronically
to ensure effective and safer practice.

Risk – Referral care providers not receiving adequate referral information which causes uncollaborated
work with health facilities towards providing the right health service to the right individual, creating
inefficient and unsafe practice.

Mitigation - The EHR systems developed supports electronic referral and ordering clinical services that
include clear data/ history of the patients, such as laboratory tests, diagnostic tests, prescriptions,
nursing care, dietary service and previous consultations.

C. Decision support – The EHR system in a health facility setting is to minimize potential medical
errors, improving safer and effective practice of Medicine by care providers.
Risk – Health care providers recording errors (manmade mistakes) that leads to unsafe and ineffective
practices for both the patients and care providers.
Mitigation- It is essential for an E H R systems to support the clinical decision making process. Thus, the
system would have; clinical guidelines, access to current clinical knowledge sources, Alert/remind for
wrong drug prescription, Alert for drug to drug interactions and Reminders for Service Appointments
and chronic care services, so that the decision process would be safe.
D. Data management, use and reporting - Collecting individual level data for health facilities in
electronic format makes the management of data, analysis, use and reporting easy.

Risk – Health care providers, regional and federal health authorities would have incorrect figures
regarding the health status of the community & society. If the system fails to produce quality report.
Incorrect figures would lead to wrong investment in health issues.

Mitigation - The EHR running in a health facility will have capability to Generate and send HMIS report,
clinical data report, visualize data with charts, Display dashboards, Export data set with a recommended
format. This reports can be accessed by the appropriate government institutions to make an informed
decision in the health sector.

E. Administrative processes – EHR used in health facilities would provide an efficient management of
health facility resources, to improve patient satisfaction and attain better control of financial flow.

Risk – Poor resource management and integrated system leads to waste of effort and time for patients
and improper financial system.

Mitigations – The EHR to facilitate efficient management system, it will be integrated with a
billing system, bed management system, queue management system and appointments management
system.

F. Exchange of electronic information - The practice of medicine demands exchange of data among
care providers and health facilities, diagnostic centers. To facilitate the data sharing activities, there
is a need to build shared health records at national level along with other services such as client
registry, facility registry, HR system and picture archival computerized system (PACS).

Risk –Failure to reach on an agreement nationally, to build a shared health records that integrate with
other functional systems. The existence of various standardized systems such as, standardized paper
form, Master Patient Index (MPI) & unique ID and pharmacy information system would result in poor
exchange of information and overall performance.

Mitigation - The EHR system would be capable of supporting individual level data exchange within
nationally defined EHR systems but with recommended standards. Therefore, the developed EHR will
have capability to interface with: Patient monitoring Devices, Laboratory machines and equipment,
Client registry, Shared health records, Care provider registry (HRIS), Radiology information system and
Supply chain management system.

G. System/Technology Adaptation – The EHR system would be a new introduction to the health
sector. The system will be managed by the Health care provider employees. Proper utilization of the
system will increase the performance and smooth running of the system.

Risk – Health care provider employees facing technology challenges, such as learning to use the EMR,
electronic connectivity, confidence with computer and ability in typing affecting the performance and
smooth running of the EMR.
Mitigation - Health facilities implementing EHR systems have clear strategies on user training. Facilities
will avail training resources and space for EHR capacity building purposes. Facilities will put in place a
Mentorship program for a specific period of time to enable end users properly use the system.

H. Power supply - The EHR is a system that is computer or electronic devise based system. For the
successful implementation of EHR systems it requires a reliable power supply system.
Risk – Continuous power outages and lack of power in the countries rural areas would affect the
utilization of the system.
Mitigation- Variety of electric power sources will be utilized for different facilities, including the main
power grid, solar power, generator power or wind power.