ST.

MARY’S UNIVERSITY
School of Graduate StudiesMA in Project Management

PROJECT RISK MANAGEMENT

Electronic Health Record System Implementation

BY
1. Kirubel Ghidey   SGS/0487/2013A
2. Laekemariam Dibabu SGS/0539/2013A
3. Meklit Ewnetu SGS/0485/2013A
4. Melaku Tesfaye SGS/0540/2013A
5. Misrak Kassahun SGS/0463/2013A
6. Mulugojjam Mekonnen SGS/0472/2013A
7. Sitota Kebede SGS/0475/2013A
8. Yonathan Daniel SGS/0503/2013A

Instructor:
Asfaw Yilma, (Ph.D.)

April, 2021
Addis Ababa, Ethiopia

i|Page
Acronym

ICT Information Communication Technology

EHR Electronic Health Record

EMR Electronic Medical Record

WHO World Health Organization

HR Health Record

USF University of South Florida

HRIS Human Resource Information System

FMEA Failure Modes and Effects Analysis

SWOT stands for Strengths, Weaknesses, Opportunities, and Threats,

ii | P a g e
Table of Contents
Acronym ii
Table of Content iii
Abstract iv
1. Introduction 1
1.1. Objectives 5
1.1.1. General Objectives 6
1.1.2. Specific Objectives 6
1.2. EMR Implementation 6
1.3. Basic Benefits of EMR 6
2. Types of Risks 6
2.1. Strategic Risk6
2.2. Schedule Risk 6
2.3. Cost Risk 6
2.4. Operational Risk 6
2.5. Legal Risk 6
2.6. Governmental Risk 6
2.7. Performance Risk 6
2.8. Risk Associated with external hazards 6
2.9. Risk Management tools failure mode & effects analysis 6
2.10. Monitor & Control Risks with Risk register 6
3. Conclusion 6
Reference 6

iii | P a g e
Abstract
The application of electronic information and communication technology (ICT) in the
healthcare system has increased worldwide. These include telehealth, mobile health
applications, electronic medical records, and health information management systems. A
survey conducted by the World Health Organization (WHO) in 2012 indicated 45% of
countries used electronic systems for patients’ data management. Besides, 30% of countries
have been collecting and communicating patient information via electronic systems.
In Ethiopia, the five-year perspective strategic plan known as health sector transformation
plan, which had been implemented from 2015 to 2020, envisioned utilization of electronic
health management information system and strengthening the electronic medical record
(EMR) system in the healthcare industry. EMR, which is a patient’s health and health-related
information record data set system, is operating based on an application of computer
software. EMR systems in the medical sectors do have numerous advantages where they
simplify service delivery and decision-making process. This has paved the way for the
increased acceptance and implementation of EMR by healthcare systems in the world
including resource-limited countries like Ethiopia, where the EMR system has been launched
by the Ministry of Health and included in the strategic plan.

The EMR system ensures high-quality documentation and easier to retrieve data system than
the paper-based medical record system. Given the high burden of disease and the increased
number of skilled personnel in Ethiopia, information quality and use remain weak,
particularly at primary healthcare facilities. This is because of deprived EMR infrastructure
aggravated by the unwillingness to use the already available technology.

The EMR system or smart care software implementation was started in Ethiopia since
2007/2008 with the help of Tulane University, whereas the adoption and utilization rate are
still insignificant and gone to back. With USD 101,805,777 funded (Mikael Gebre-Mariam -
EMR Implementation Framework, June 2012) for the projects total the healthcare institutions
that already started to use the EMR system were unable to sustain the

iv | P a g e
Introduction
An EMR is computer software used to capture, store, and share patient data in a
structured way. An EMR is able to share medical information among all the
authorized parties involved in the patient’s care: clinicians, labs, pharmacies,
emergency facilities, nursing homes, state registries, and patients themselves. If health
data is recorded electronically, data will be found timely without distortion, at least
comparing to paper-based data.

EMR systems in the medical sectors do have numerous advantages where they
simplify service delivery and decision-making process. EMR systems are being
implemented in many countries to support healthcare services. However, its adoption
rate remains low, especially in developing countries due to technological, financial,
and organizational factors.

Implementing an electronic health record (EMR) has the potential to enhance

healthcare delivery and expedite reimbursements. However, there are several
significant risks for providers. Converting a manual system, or updating to a
customized system, can be overwhelming for patients and staff members. many
providers either delay implementing an EMR or fail to adequately prepare, exposing
themselves to increased financial risks.

Although EMRs have created new opportunities in healthcare, they are not without
risk. Issues related to documentation, data overload, and privacy/security of health
information represent some of the main concerns. Physicians and healthcare
organizations can mitigate EMR risks by developing policies and procedures that
address top concerns and emerging issues, gaining familiarity with the concept of
both the electronic and printed format of records, and conducting regular audits to
identify potential problems or gaps in policy.

1|Page
Objectives
General Objective
The main objectives of EMR are improving the quality of care by reducing medical
errors, providing an effective means of communication, sharing information between
healthcare providers.
Specific objective
 System should decrease cost for supplies and paper management.
 Decrease waiting room time for patients.
 The system should improve patient access to services.

EMR implementation
• Inadequate confidentiality of medical records
• Limited access to complete patient info
Causal Conditions for • Medication errors & drug interaction
EMR implementation • Laborious lab investigation requisition process
• Disparities in clinician communication
• Shortage of HR
• Heavy patient load
Clinic working • Heavy workload
conditions • Shortage of space
• Unavailability of supplies
• Energy (electricity)
Basic Infrastructure • Communication (networks, Internet)
• Technical limitations of system
Technological & Cost • Lack of trained technical staff
• Hardware & software
• Cost related to EMR implementation
User • Computer & EMR training
• EMR acceptance
• Workflow redesign
• Project management & control
• Timely access to complete medical record
• Patient care efficiency

2|Page
 • Reduced medication errors
Organization and user • Improved patient confidentiality
Intervening Conditions •Improved communication b/n clinicians
• Clinical decision support
• Integration of programs
• Data entry and retrieval efficiency
• Timely and accurate reporting
• Reduced patient-clinician interaction

3|Page
Basic Benefits of EMR

 Better Quality of Care

o Quick access to patient records
o Increase treatment effectiveness
o Recommends potential treatment options
o Patient portals give patients access to their medical details
o Makes patient-physician communication better
o Improves preventive care
o Streamline office coordination
o Less cluttered office space due to charts being store digitally
o Quickly transfer data inside and outside of your office
o Increase patient engagement and compliance among your patient base
o Increase patient safety through the reduction in medical errors
 More Accurate Patient Information
o Makes accessing patient information easier
o Reduces the risk of theft of sensitive data
o Lowers mistakes due to handwriting
o Update and access patient information in real time
o Continuity of treatment
 Interoperability
o It interface with other systems, which allow medical practices to optimize
continuity of care.
 Increased Efficiency
o Built-in templates for physicians
o Artificial Intelligence assists with diagnosis and interpretation of reports
o E-prescribing saves time
o Reduces the abuse of controlled substances
o Check automatically for drug-to-drug or drug-to-allergy reactions
 Increase in Revenue Recap:
o Provides billing and payment tools
o Reduces rejection rates of insurance claims

4|Page
 o Governments provide monetary incentives to EHR users
o Increases first-time acceptance rates for claims
 Scalability
o Third-party EHR software can grow and scale up to include larger patient
bases as medical practices expand.
 Accessibility
o Online access makes EMR very accessible.
 Security
o The health records are protected.

Challenges of Electronic Medical Records EMR

First, the usage of the system was found to be low. To increase the use of the system, most of
the physicians expressed the need to hire secretaries as the nurses expressed a lack of time to
input information and the proper maintenance of computers, and the laboratory and pharmacy
staff complained about the lack of use of the system by other departments. This result is not
actually surprising given that health professionals are expected to do dual documentation both
on the computer and on paper which makes them feel that transferring data to the EMR is not
their duty. Hence, most of the doctors and the nurses were complaining about the lack of time
and most of them demanded secretaries to be hired so that the secretary can transfer the paper
documentation to the EMR. The other aspect of the challenge is the partial use of the system
in the hospital departments. Hospital work flows are interconnected, in which the activity of
one department affects the other. Therefore, there is a need to implement the system to
interdependent departments especially to those that are pillars of the hospital system (eg,
laboratory, pharmacy, and radiology).

Second, the result of this study shows that only 2 of the core EMR functions were frequently
used, 3 of the functionalities were never used, and participants were also unaware of 4 out of
12 core EMR functions. The participants enrolled in this study were all employed for >6
months. Thus, they were likely to be familiar with the main system functionalities. The low
rate of use and awareness might be attributed to the general low adaptation rate of the EMR
in the hospital and the training quality.

Third, the user satisfaction of the respondents was also found to be low. The majority of them
reported to be dissatisfied with the use of the system. The main reported reason of the

5|Page
dissatisfaction was the service quality in the hospital. This was mainly due to lack of IT
support, the shared computer access, and frequent power interruption.

Fourth, the user satisfaction was strongly correlated with service quality and system use. It
was also moderately correlated with IT qualification, computer access method, perceived
system, and information quality. Given the infrastructural and organizational challenges, such
a strong correlation between service quality and use and user satisfaction was expected.
However, the level of strength of the relationship was high, which shows that there was a
need to improve the service quality and the current way of using the EMR in the hospitals.

RISKS IN IMPLEMENTING EMR

STRATEGIC RISK
To make the adoption of EMR systems successful in hospitals, it is important to look at the
benefits, risks, and barriers based on the size of the hospital. The survey results indicated a
significant relationship in some benefits and barriers to adoption of EMR systems based on
the size of the hospital. However, due to the low response rate, these findings may not be
generalize to other hospitals throughout the country. If built for various hospital sizes, EMR
systems could reduce barriers such as hardware costs for small hospitals, and could increase
benefits such as work efficiency and time management by implementing process
improvement for large hospitals. Specialized software systems such as EMR systems need
not come in one size fits all.
And for the better result the ministry of health or any organization who responsible for EMR
must have clear policy and strategy for the following issues as Strategic risks.
Strategic risks are those that arise from the fundamental decisions that directors take
concerning an organization’s objectives. Essentially, strategic risks are the risks of failing to
achieve these business objectives.
Strategic risks are mainly the asset owner’s (or sponsor’s) responsibility: strategic risks are
the responsibility of management, not the project team.
Adopt collaborative strategies to include all users of the system when evaluating the need to
make changes or updates.
 Set stringent documentation guidelines and eliminate workaround processes.
 Tailor the system’s alert function to specific patient populations.
 Use system reporting functions to support an active performance improvement plan
for risk reduction.

6|Page
  Develop a comprehensive policy to define the legal patient record.

People
Unfortunately, not everyone is on board with the idea of implementing and using EHRs.
There will be patients and providers along the way that may reject EMR or easily give up on
them if there are initial technical malfunctions. Before bringing EMR into your practice,
consider the barrier may face with patients and coworkers – it’s important to be ready to face
each and every opinion.
 Risks – Its always important to know the knowledge of the employee before taking
them in a new system, otherwise there will be a lack of interest of working
 Mitigation – To have an adequate continuous training it’s very important to adapt the
work very easy and to make the employees capable.
Workflow break up
One of the main purposes of implementing EMR is to create a steady workflow in the
practice.
 Risk - Unfortunately, getting Paid said sometimes EMR implementation can mess up
the workflow in a practice entirely if it is not customized to fit its purpose properly.
 Mitigation - To avoid this problem, make certain vendor gives a proper
demonstration of how the implementation will work in practice.
Training

During EMR implementation, practices are suggested to train employees throughout the new
and improved workflow process.
 Risks - This takes extra time, effort and resources some practices may not be able to
afford.
 Mitigation - Before agreeing to implement EMR, find out exactly how much training
should go into the process and only go through with it if your practice is ready to
complete it.
Training is one of the most important parts for successful EMR implementation.
Concerns with privacy
According to USF Health, some healthcare providers and patients may be concerned about
medical privacies when using EMR.

7|Page
  Risks - Common concerns include lost information due to a natural disaster and cyber
hacks.
 Mitigation - Before implementing EMR, ask questions in regard to how strict privacy
will be in your new system.

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

8|Page
 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 EHR 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 report 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 inefficient
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

9|Page
 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.

10 | P a g e
 COST RISK
The Cost
Cost is one of the most important factors to consider. Depending on which vendor you work
with, the cost to implement your new EMR  and use it could be more expensive than initial
budget anticipated. To apply EMR there was assessment whether the hospitals, health cares,
clinics or the health posts needs and extra cost to use the EMR system so they are divided in
two major group to know how much cost they need.
The EMR implementation gross cost has been divided into two major categories that are: -
I. Hospital Out of Site Cost
In most of the hospitals there are lack of the basic equipment problems to apply the EMR
system majorly are divide into four categories: -
 Pre-deployment work cost
Before Implementation there were several costs in a process of applying the
ERM system to start the project like the availability of the infrastructure like
internet connection and others.
 Deployment Cost
In the development process there were some assessments on how fast to apply
the EMR system so there were different disciplines who involves in these
tasks.
 Training & Mentoring Cost
To use EMR system the pediatricians and some of the employees must be train
and to adapt to this new system so there is a cost for a training.
 Material Cost
Beside the basic need for a hospital material to apply the EMR there was a
lack of computers and others material so the cost for those materials was very
high.
E.g. Selam Health Center EMR Implementation Gross Cost
Hospital out of site cost
Selam Health Center EMR implementation gross cost
S Cost Category Cost (ETB)

11 | P a g e
 N
1 Pre-deployment work Cost 61,000.00
2 Deployment Cost 257,000.00
3 Training and Mentoring Cost 101,840.00
4 Material Cost 3,732,320.00
Total cost 4,152,160.00

II. Hospital in Site cost

In a standard hospital there are basic systems that they use for their work so to apply the
EMR system is quite easy, but to use EMR system they still need some cost that are: -
 Training & Mentoring Cost
To use EMR system the pediatricians and some of the employees must be
train and to adapt to this new system so there is a cost for a training.
 Material Cost
Beside the basic need for a hospital material to apply the EMR there was a
lack of computers and others material so the cost for those materials was very
high.
E.g. Hospital on site cost
Hospital on site cost
EMR implementation gross cost
S
N Cost Category Cost (ETB)
1 Pre-deployment work Cost -
2 Deployment Cost -
3 Training and Mentoring Cost 101,840.00
4 Material Cost 3,732,320.00
Total cost 3,834,160.00

In the cost risk there were several issues that can be measured as a factor affecting the EMR
system project.
 Risk - It require extra money beside the system itself like providing training for the
employees, while taking training assign other employees in replace and time that
they may consume to practice is counted as an extra expense.
– Because the project fails all the cost applied are risks
 Mitigations - The knowledge and skill level of your staff must be taken into
account as well. Savvier employees will pick up the basics of using the EMR
software pretty quickly

12 | P a g e
 Stakeholders should understand that while EMR deployment has some up-front
costs that need to absorb, in the long run, this software will save time and money.
The return on investment is not just financial, of course. Staff will have better
morale because they are less stressed now that have a robust EMR in place and
patients will appreciate.

OPERATIONAL RISK
Due to the poor implementation and process or not be familiar to the system of EMR some of
the professionals they are not comfortable to use or to implement in their work.
 Risks - To gain improvements in clinical care and patient safety, the various technology
components have to be used.
 To be used, the various technology components, such as clinical decision support
features, have to be relevant to physicians.
 The vast number of metadata created in an EMR could be used against the
physician defendant.
 Information created by an EMR has to be accurate and useful.
 The confidentiality, security, and integrity of the patients’ electronic records have
to be maintained.
 Mitigation - Utilize appropriate clinical decision support tools, including alerts,
guidelines, tracking, and reminder functions.
 If you choose to override or ignore an alert or reminder, document briefly
the clinical justification.
 Avoid cutting and pasting.
 Ensure appropriate, applicable templates; understand the automatic
populating features and default language.
 Ensure appropriate data input and retrieval.
 Periodically print out a patient record and evaluate for adequacy. Would
another clinician (such as a subsequent provider or an expert witness) be
able to understand what happened in treatment and why?
 Understand metadata – and the fact that the user’s every key stroke will be
tracked and recorded.

13 | P a g e
  Ensure appropriate security protections on hardware (including portable
devices) and software; an example is an automatic lock-out after a specified
period of inactivity.
 Ensure compliance with federal and state confidentiality law, including
confidentiality agreements with those third parties accessing EMR.
 Prevent inappropriate access and disclosure; appropriate employee training
is key.

LEGAL RISK

In a legal risk there is internal & external risk factors that can affect the system of EMR, in
many aspects the usefulness of these system its very important for the hospital at the same
time for the patient.
a) Internal Legal Risk
Evey patient’s medical history is recorded in the EMR system, while most EHR systems are
safe and secure, doctors and practice managers still have legitimate worries about data
breaches caused by ransomware and other cyber security hacks.
Privacy issues faced by most practices include data tampering, loss of data following a
natural disaster, and unauthorized access to patient information, noted a recent article
from USF Health. Response should be to factor such risks as select a security policy. Work
with software vendor and IT department to iron out any kinks as shore up the firewall and
other protections.
Privacy & Security
 Risks – The patient privacy it’s very important to maintain secretively
 Mitigation – Use patients’ history when is need or when a legal agent asks for the
information so there must be some sort of legal ground for these.
b) External Legal Risks
In the useful of EMR its very important to simplify the workflow, time saving, money saving
and upgrade of the medical system as well. In the application of EMR in Ethiopia has been
initially tested in a four selected hospital that has a remarkable result but some hospital
wouldn’t accept to use this system.
Rule & Regulation
To have a legal and regulation obligation it’s very important to sustain the project for a longer
time

14 | P a g e
  Risks – While applying EMR systems the unwillingness of health care’s professional
to use EMR is one of the problems
Litigation between the professional not using the EMR brough against the
Organization
 Mitigation – While applying a new system depending on the advantage of the project
it’s always important to set a rule and regulations in this case the Heath
ministry has a big role to obligate to use this system, in order to have a
sustainable system and to stay for longer.

RISK ASSOCIATED WITH EXTERNAL HAZARDS IMPLEMENTATION SYSTEM

OF ELECTRONIC HEALTH RECORD
Risks that are associated with the external factors are rarely happen because of the moderate
environment like storm, floods, earthquakes and others but in order to take full responsibility
it’s always better to be prepared for the consequence to take the risk beside the natural
disaster there are some external hazards listed below like:-
 Risks - Security Risks from Criminal Computer Hackers
 Data Bottlenecks Because of a Poorly Designed Interface
 Individuals with poor typing skills may be slowed down using an EMR. ...
 Preparing your organization to deploy an electronic health records system.
 Risks - financial risk (billing errors in software), software systems becoming
obsolete, software vendors going out of business, computer crashes, data capture
anomalies, programming errors, automated process issues, and populating invalid
information in the decision support systems module of EMR.
 related perceived  summary and discussion the most significant barriers were lack of
national information standards and code sets, lack of available funding, concern about
physician, and lack of interoperability.
 The barriers identified were categorized into the information systems resources. The
review suggests that people resource (user resistance and lack of skills) and procedure
resource (concern for return on investment and lack of administrative and policy
support) are the primary barriers to overcome.
 Mitigation – In order to defend a criminal computer hacker, it needs a well-
organized server in order to prevent this problem, once this system is
practiced in the society then it’s easy to train the individuals once they
understand the useful and the easiest method.

15 | P a g e
RISKS THAT ENCOUNTERED AFTER IMPLEMENTING EMR
EMR is one of problem solving, time saving, money saving & labor saving for both
pediatrician and clients or patients, even though has many benefits also as a county but
there are some other factors after implementing EMR. The problems are internal &
external factors that may difficult to use EMR in every hospital public & private. Thus,
listed below are risks that might be faced after the implementation.

a. Usability
Education is key whenever you implement new software. Without proper training, it can be
difficult for some medical practices to learn how to use the EMR system. Sometimes the
problem lies not with user error but with the system itself, which may have a clunky interface
with options that are hard to find. For example, ADS’ own Window One architecture places
needed data at the user’s fingertips in virtually every Medics Doc Assistant window view,
dramatically reducing keystrokes and mouse clicks and optimizing encounter capture. As
bottlenecks are eliminated, your staff enjoys increased workflow. What’s more, the system
operates in real time. Newly inputted data is visible by all authorized users across the entire
enterprise as soon as the patient information is entered.

b. Time and Data Migration

When you install the EMR software, you will have a lot of patient records now on paper that
you’ll have to bring into the system.

 Risk - Transcribing paper records into the EMR system can be time-consuming.
Someone will have to type it in, and the risk is that medical professionals must make
sure that no information is lost in the process. You’ll need to be realistic about how
long the process will actually take, noted a report from Healthcare Business &
Technology.
 Mitigation–Once the information is install in the system it’s easy to access at any
time they need, even though the recording it’s time taking but the outcome has a big
payback.
c. Interoperability

16 | P a g e
The ability of computer system or software to exchange and make use of information is very
important EMR software helps the pediatrician and patients to be diagnosis.
 Risk – Beside EMR there are many various systems, application running in busy
medical practice, of course, new  EMR software system will not be the only.
Lack of interoperability is a major risk that need to account for before purchasing
EMR application, otherwise one won’t be able to share patient information well.
 Mitigation – Creating a capable employee who can use different interoperability it’s
very important to minimize the work load of the workers.
d. Technical ability
A computer’s abilities, knowledge to retrieve and send data is needed to perform specific task
to send data throughout healthcare.
 Risk - The data it’s very useful for the hospital, care center, clinic etc. but if there is a
technical problem on the system that means there is a risk of data collection and the
system will be down specially in the rural area.
 Mitigation – Depending on the size of the hospital or health care there must be a
technical person, while stopping a paper data collection we need to prepare a technical
person who take care of the problem.

RISK MANAGEMENT TOOL FAILURE MODE AND EFFECTS ANALYSIS

 Applying FMEA in EMR implementation

After the Health Information Technology for Economic and Clinical Health (HITECH) Act
was promulgated in 2009, EMR were more widely adopted. Many healthcare organizations
are undertaking EMR implementation projects or updating information technology processes.
Risk management is needed for EMR systems so that undesirable events can be ruled out and
prevented whenever possible.

Choosing the EMR implementation process is an ideal example to illustrate the application of
FMEA, the first three steps are assumed. The topic is identified and a team is in place. An
analysis of workflow has been completed because EMR implementation projects are
generally led by a professional project team. The team will usually consist of a project
manager, sponsors, and representatives from each department/unit. To illustrate FMEA, this
article will focus on the next steps in the analysis, which consist of risk assessment and
control.

17 | P a g e
First, what are the risks in EMR implementation? Risk identification methods include
brainstorming, interviews, root cause analysis, SWOT analysis, and experience. The risk
management team can use any method to identify the risks. assign each risk factor a rating for
severity and probability. In practice, one risk item will impact several aspects of the project,
including cost, time, scope, and quality, which are the key criteria to assess the
implementation success. 

MONITOR AND CONTROL RISKS WITH RISK REGISTER

The purpose of risk management is to reduce the chance of failure. Therefore, assessing the
severity and probability of each risk item with FMEA is the identification and assessment
segments of risk management. Once FMEA is completed, the healthcare management team is
able to create the risk register to monitor and control risk as much as possible. In the case
illustration of EMR implementation, the root cause of inadequate training is examined as one
risk included in the risk register. For this risk factor, the cause may be simple—insufficient
training due to neglect on the part of management.

The next step is to take action to monitor and control risks. The risk management should pay
more attention to risk factors assessed as high to medium to alleviate its impacts. Actions
include avoiding, transferring, mitigating, and accepting a risk. Avoiding a risk is to ensure
the risk will not happen by changing the plan or process. For example, to address inadequate
training, managers can prepare in advance by requiring more training from the vendor and
providing additional on-site or on-line assistance.

The most common form of transferring a risk is to purchase insurance. For example, in an
EMR implementation project, purchasing additional billing insurance can alleviate the
potential negative impacts due to billing errors during use of the new EMR system.
Outsourcing is another popular approach in risk transferring. If the hospital has limited
experience in data conversion during EMR implementation, it can contract out this work to a
data conversion specialist. If there is no way to avoid or transfer risk, then mitigating the risk
is needed. For example, with system incompatibility, the organization can allocate more
capital resources to replace obsolete systems. This will require mobilizing the contingency
plan for extra resources, such as labor and cost. Finally, if nothing can be done, the
organization will have to accept the risk.

18 | P a g e
The next step involves the development of a risk response plan for each of the risk items.
Each risk item has its critical date, such as with EMR implementation, where some risk items
are approaching, while others are not urgent. 

It is important to note that to continue monitoring and updating the register weekly or
monthly. Some risks, such as data privacy compliance, will not influence the project for 6
months, so the current status may be noted as “not applicable” until further information is
obtained and the timeline is reached.

Conclusion

The implementation of EMR systems in a developing country context is a challenging

process. Understanding clinicians’ information needs for patient monitoring and decision-
making in-patient care is an essential phase in developing knowledge and gaining
understanding on how EMRs can be effectively deployed and utilized care. The attitude of
clinicians concerning the implementation of EMR systems was overwhelmingly positive. The
perceived benefits of EMRs are improved continuity of care, timely access to complete
medical record, patient care efficiency, reduced medication errors, improved patient
confidentiality, improved communication between clinicians, and integration of various
programs, timely decision support and overall job motivation. On the other hand, drawbacks
to EMR implementation include productivity loss and negative impact on the interaction and
relationship between clinicians and their patients. The findings of this study led to the
development of a conceptual framework encompassing key factors including infrastructural,
organizational, and technological and user attributes essential for successful EMR
implementation in a developing country.

19 | P a g e
Reference
 Ethiopia Country Operational Plan (COP/ROP) 2018Strategic Direction Summary
May 17, 2018 PEPFAR
 ETHIOPIAN HOSPITAL SERVICESTRANSFORMATION GUIDELINES Volume
1, September2016
 Health Information Systems in Developing Countries A Landscape Analysis
 A Force for Good at the Local, Regional, and Global Levels the Economic and Social
Impact of Tulane University May 2009
 REVITALIZING THE SMARTCARE SYSTEM OFSURGERY INPATIENT
DEPARTMENT IN SAINT PAUL HOSPITAL MILLENNIUM MEDICAL
COLLEGE BY YESHIMEBET KASSAHUN JUNE /2014
 NVESTIGATING ELECTRO MEDICAL RECORD (SMART CARE SOFTWARE)
IMPLEMENTATION IN A HEALTH CARE FACILITY: A GUIDING
FRAMEWORK FOR ADAMA HOSPITAL MEDICAL COLLEGE BY: DILARG
ALEMAYEHU JUNE, 2015
 Enhancing Information Security and Privacy of Health Information System: A case of
Open MRS Selemawit Hadush Kidanu April, 2015
 An Electronic Medical Record (EMR) Implementation Framework for HIV Care and
Treatment Facilities in Ethiopia (Mikael Gebre-Mariam, Elizabeth Borycki, Andre
Kushniruk and Mary Ellen Pur)
 Medical Record Documentation System in Ethiopia, Addisu Tadesse Sahile1*,
Mussie Wubshet Teka2, Mikias Ababu Teshome2 and Tilahun Desalegn Jata
(Published: October 12, 2020)
 ELECTRONIC SOLUTIONS FOR ETHIOPIAN HEALTH SECTOR Electronic
medical record (EMR) system, Tewodros Mengesha, Autumn 2011 Business
Information Technology Oulu University of Applied Sciences
 https://www.cdc.gov/globalhivtb/who-we-are/success-stories/success-story-pages/
innovativemalawi.html

20 | P a g e
21 | P a g e