ST.

MARY’S UNIVERSITY
School of Graduate Studies MA in Project Management

PROJECT RISK MANAGEMENT

Electronic Health Record System Implementation

BY
1. Kirubel Ghidey   SGS/0487/2013A
2. Lakemariam 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

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Abstract

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TABLE OF CONTENT
Abstract …………………….……………………………………………......................ii
Table of contents …………...….…………………………………...…………….…….... iii
Company Background.………………………………….…………………….…...……......
1
1. Introduction........................................................................................................................3
1.1 Objectives.......................................................................................................................4
1.2 EMR Implementation ................................................................................................5
1.3 Basic Benefits of EMR.................................................................................................6
2. Types of Risks.....................................................................................................................6
2.1 Strategic Risk...............................................................................................................6
2.1.1 Peopless...............................................................................................................7
2.1.2 Workflow break up...........................................................................................7
2.1.3 Training..............................................................................................................7
2.2.4 Concerns with privacy......................................................................................7
2.2 Risks Associated with External Hazards implementation System of EMR............8
2.2.1 Problem with electronic health records...........................................................8
2.3 Risks that encountered after implementing EMR (Governmental Risk)..............9
2.3.1 The Cost.............................................................................................................9
2.3.2 Security and Privacy Violations.......................................................................9
2.3.3 Usability.............................................................................................................9
2.3.4 Time and Data Migration...............................................................................10
2.3.5 Interoperability...............................................................................................10
2.3.6 Technical ability..............................................................................................10
2.4 Operational Risk......................................................................................................10
2.4.1 Risk Management Issues................................................................................10
2.3.2 Risk Management Tips ..................................................................................11
2.5 Performance Risk.....................................................................................................11
A. Demographic and Health information..............................................................11
B. Referral management ........................................................................................12
C. Decision support.................................................................................................12
D. Data management, use and reporting..............................................................12
E. Administrative processes....................................................................................13
F. Exchange of electronic information...................................................................13
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 G. System/Technology Adaptation.........................................................................13
H. Power supply.......................................................................................................14
2.6 Risk management tools failure mode & effects analysis.......................................14
2.7 Monitor and Control Risks with Risk Register.....................................................15
2.8 Conclution.................................................................................................................16
Reference...............................................................................................................................17

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Company Background

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. In other words, it is as an electronic
software program developed for the storage, processing, and exchange of medical and
medical-related information, and the patients’ data can be created, gathered, managed,
and consulted by authorized clinicians or staff within healthcare organizations. 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. According to the research
finding, retrieving evidences through EMR system was 40% more complete and 20%
faster than paper records. A study in Malawi in 2017 also indicated that 76% of health
workers preferred to work in healthcare facilities which had installed the EMR
system, justifying that the system is fast and easy to use. Additionally, 77.8% of
respondents supported that the electronic healthcare data management system was
more accurate, and as a result, the patients were served more quickly. On the contrary,
paper-based prescriptions had 18.5% of reading error for the actual medication and

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also had lack of patient confidentiality and privacy due to unauthorized users who can
easily access information (W. Lynn, M. Joy, and S. Rogers 2017). A significant
number of medical errors around the globe are accustomed to weak EMR program
and data system functioning and willingness to use EMR by health experts. Findings
from North Carolina indicated that one in seven Medicare patients suffered harm and
63% of the harms were attributed to hospital medical care although 44% of the
medical care errors were preventable if the installed EMR system was used by
healthcare professionals enthusiastically.

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 (M. K. B. Msukwa, 2011). This
makes surveillance systems and health communication among different healthcare
organizations and professionals very difficult. A survey conducted between 2008-
2009 on health personals’ willingness to use EMR discovered that 42.3% of physician
had willingness to use patients’ electronic health records during clinical practices.
Whereas, another study carried out in Saudi Arabia revealed that 83% of healthcare
professional preferably use EMR system than paper-based system (S. Biruk, T.
Yilma, M. Andualem, and B. Tilahun 2014).

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 for the
projects total the healthcare institutions that already started to use the EMR system
were unable to sustain the EMR system. Most of the strategies in Ethiopia are
emphasized on the material aspect particularly the installations and infrastructure of
EMR systems and have ignored the attitudinal and behavioral factors (willingness) of
healthcare practitioners in using the EMR system as supported by a study conducted
in Ayder Referral Hospital, Northern Ethiopia, which showed that a significant
number of professionals (43.3%) had unfavorable attitude towards EMR system use.
Although Ethiopia has been trying to implement the EMR system at a small-scale
level.

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 1. Introduction

An electronic medical record (EMR) is the systematized collection of electronically-

stored demographics and health information (e.g., medical history, medications, test
results, billing data, etc.) on patients in a digital format.

Electronic Health Record will help transform all paper and film into computer process
able bits and bytes so patients and their doctors have access to this essential data
whenever and wherever they need it. It will also have a profound impact on the
efficiency and quality of the health care system.

An electronic health record is a means or method of improving or bringing the

required service on a timely fashion. Health data should be recorded electronically
and accessed by professionals, such as physicians and nurses. These professionals
could be found in various areas of a country. If health data is recorded electronically,
data will be found timely without distortion, at least comparing to paper-based data.

EHR systems in the medical sectors do have numerous advantages where they
simplify service delivery and decision-making process. Electronic Health record
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. There is lack of solid evidence
and empirical research regarding the pre implementation readiness of healthcare
providers.

The Electronic Health Record (EHR) will allow physicians and patients to share
information and knowledge about patients' medical status so that effective medical
and self-management can occur.

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 1.1 Objectives

The objective of this study is to assess the usage pattern, user satisfaction level, and
determinants of health professional’s satisfaction towards a comprehensive EMR
system implemented in Ethiopia where parallel documentation using the EMR and the
paper-based medical records is in practice. Since 2007/2008, there have been
insignificant numbers of studies conducted on EMR among medical practitioners.
Electronic medical record (EMR) systems are increasingly being implemented in
hospitals to achieve the following six aims of improved care:
(1) safety,
(2) effectiveness,
(3) patient centeredness,
(4) timeliness,
(5) efficiency, and
(6) quality.
However, many EMR systems which are technically sound for developers and
healthcare managers, face resistance from users and may end up in failure
EHR assessments, audits and risk assessments are vital for a few reasons.
The first reason is to ensure healthcare organizations maintain compliance with
meaningful use guidelines. For the uninitiated, meaningful use refers to minimum US
government standards for electronic health records. These standards explain how all
stakeholders in the healthcare chain, such as providers and insurance companies,
should share patient data.
The primary intent of meaningful use is to boost collaboration and data exchange as
well as support the development of robust systems.

Organizations that meet meaningful use guidelines can qualify for incentive payments
under the Medicare EHR Incentive Program — designed to spur the transition to EHR
by reimbursing some of the costs required. However, healthcare organizations might
be audited to ensure that they’ve met meaningful use guidelines. About a quarter of
all audited organizations claiming incentive payments have failed their audit, mainly
because they didn’t follow the guidelines to the spirit.

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Another reason to conduct an EHR audit and risk assessment is to guard against data
breaches and theft.

1.2 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
• 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

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• Timely and accurate reporting
• Reduced patient-clinician interaction

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 1.3 Basic Benefits of EMR

The Benefits of EMR are a lot as it ends the Slows and Lagging System Performance or old
paper-based system, and it has a better advantage as listed below

 Access your electronic health records quickly

 Eliminate non-performing workflows
 Put an end to slow chart retrievals
 Enjoy fast response times and system logins
 Ensure the patient data you need is there when you need it
 Serve More Patients and Improve Their Experiences

2. TYPES OF RISKS
2.1 Strategic risk
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.
 Develop a comprehensive policy to define the legal patient record.
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
generalizable 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.

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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. In contrast, the authors suggest that
the project team is perhaps better placed to identify some strategic risks long before they
come to management’s attention.
2.1.1 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.
2.1.2 Workflow break up

One of the main purposes of implementing EMR is to create a steady workflow in the
practice. 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. To avoid this
problem, make certain vendor gives a proper demonstration of how the implementation will
work in practice.
2.1.3 Training

During EMR implementation, practices are suggested to train employees throughout the new
and improved workflow process. Unfortunately, this takes extra time, effort and resources
some practices may not be able to afford. 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.
2.1.4 Concerns with privacy

According to USF Health, some healthcare providers and patients may be concerned about
medical privacies when using EMR. Common concerns include lost information due to a
natural disaster and cyber hacks. Before implementing EMR, ask questions in regard to how
strict privacy will be in your new system.

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 2.2 Risk Associated with External Hazards Implementation System of Electronic
Health Record
2.2.1 Problems with Electronic Health Records
 Security Risks from Criminal Computer Hackers
 Data Bottlenecks Because of a Poorly Designed Interface
 Staff Needs Training to Switch from Paper to Electronic Health Records.
 Individuals with poor typing skills may be slowed down using an EMR. ...
 Preparing your organization to deploy an electronic health records system.

1. Cost of Implementation.
2 Staff Resistance.
3  Training is time-consuming.
4 Lack of usability.
5 Data Privacy.
6 Data Migration.
7 Limitation of Technical Resources.
8 Interoperability.
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.
Background and related perceived risks, benefits  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.

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 2.3 Risks that encountered after implementing EMR (Governmental Risk)
2.3.1 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.
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, but others may
require extra training and support.
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.

2.3.2 Security and Privacy Violations

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.

2.3.3 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

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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.

2.3.4 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. 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.

2.3.5 Interoperability

New  EMR software system will not be the only application running in busy medical practice,
of course. Lack of interoperability is a major risk that need to account for before purchasing
EMR application. Without this capability, one won’t be able to share patient information.
2.3.6 Technical ability

A computer’s ability to retrieve and send data throughout healthcare is affected by its age and
other factors, such as the area in which the practice is located. Connecting to the system and
internet can be more difficult for a system that is located in a rural setting over an urban
region. Make certain the location of practice will make EMR implementation and usage a
non-stressful task.
2.4 Operational Risk
2.4.1 Risk Management Issues:
 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 amount of metadata created in an EMR could be used against the physician
defendant.
 Information created by an EMR has to be accurate and useful.

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  The confidentiality, security, and integrity of the patients’ electronic records have to
be maintained.
2.4.2 Risk Management Tips:
 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.
 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.
2.5 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

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 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 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.

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  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

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 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.
2.6 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

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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.

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. 

2.7 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

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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.

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.

2.8 Conclusion

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

process. Understanding clinicians’ information needs for patient monitoring and 0decision-
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.

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Reference

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