INTERACTIONS WITH ELECTRONIC MEDICAL RECORD SYSTEMS OF RURAL PRIMARY HEALTH FACILITIES DURING THE COVID-19 PANDEMIC

Abstract

In 2016, the Philippine Health Insurance Corporation (PhilHealth) mandated that all primary health care facilities use electronic medical records (EMRs). Challenges surrounding the transition from paper-based records to EMRs in the country included regular usage and adoption of technology by the health care service providers. The Covid-19 pandemic added another layer of difficulty as the country’s health system, particularly its human resources, was burdened. According to the Association of Southeast Asian Nations (ASEAN) Comprehensive Recovery Framework, overcoming the pandemic necessitates strengthening health systems. To achieve this, efficient adoption of EMRs must be done to support capability for pandemic response and preparedness. To understand EMR adoption, we extracted and analyzed more than 270,000 EMR usage logs in 2020. We examined how selected rural public primary health care facilities interacted with EMRs before and during the Covid-19 pandemic by estimating the total duration of all EMR actions per workday and identifying the type of EMR feature commonly used. Results showed that the facilities had varying levels of interactions with EMR. Average use per workday ranged from almost none to more than eight hours in the facilities. Some facilities had a statistical increase in duration of use and type of features used during the pandemic while the opposite was observed in some. This study demonstrates that EMR users had varying levels of adoption before and during the pandemic. Our results suggest that despite increased interactions with the EMR, in terms of time and type of activities, complete adoption of the system four years after implementation, has been slow. The pandemic has also affected the EMR interactions of facilities differently and may have further delayed progress in adoption of some users. Our study highlights the need not only for training on EMRs but also the need to demonstrate and highlight feature-specific adoption to understand its potential for wider health system uses, building on trust and competence with technology.  Future research can explore other aspects to the technology, such as use of games or non-monetary incentives to examine for user behavior and performance improvements.