Date of Award

January 2017

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Karen J. Jubanyik

Abstract

Electronic Medical Records (EMRs) have shown benefit for clinical, organizational, and societal outcomes(1). In South Africa, the desire for effective record keeping will continue to rise with increasing trauma and infectious disease rates. Recognizing this, the Western Cape government in 1999 signed a tender to rollout Clinicom EMR, an online storage system for paper records, to all hospitals within the province(2).

In 2012, Khayelitsha Hospital (KH) was opened with the Clinicom EMR installed. In 2013, KH received the ministerial award for clinical excellence as a result of the effective EMR rollout. Due to a high incidence of violence around Khayelitsha, and the need for effective trauma surveillance for efficient resource allocation, the authors sought to calculate the Emergency Center (EC) trauma rate for KH. Retrospective review of both paper charts and the Clinicom EMR from July 2012 to May 2013 was performed.

The Clinicom EMR yielded a mean monthly EC trauma visit of 280 patients, mean EC census of 3537 patients and a mean trauma rate of 8%. The latter was much lower than the nationwide estimate of 33%. For the month of July, 66 additional cases were found on the paper registry but not on the EMR. Furthermore for the months of January to May 2013, scanned copies of patient records were unavailable on the EMR online database.

The discrepancy between the paper records and the EMR suggest potential difficulties with the implementation of the Clinicom EMR that were overlooked by the award committee, and call into question the 8% trauma rate calculated. The results highlight the need for further evaluation of the functioning of the Clinicom EMR system to identify difficulties in implementation and correct them before the system is utilized in hospitals across South Africa.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 01/01/2021

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