Shifting focus to the EMR Project

After two weeks of Spanish emersion, we are finally shifting the focus of the majority of our time to our project: the implementation of an EMR system in Totonicapan hospital.  On Monday(June 20), we had our first meeting with Roberto, the programmer of the system, in order to learn how to operate the software he had spent the last several months building. The meeting proved to be a test of our Spanish abilities, as we spent the morning communicating only in Spanish as we were introduced to the software. With only minimal assistance from, we were able to effectively learn the software and recommend a few small changes to Roberto. Upon the conclusion of the meeting, we felt confident that our two weeks at Celas Maya had prepared us well, and that we could communicate effectively with Guatemalan professionals in Spanish.

The initial version of the EMR software, known as SABER only includes a few features, but is simple to use and navigate. We feel it is important that the transition from paper medical records to electronic records happens in slow, small steps so we can anticipate and quickly correct any problems that occur. SABER 1.0 consists of a web browser-based form with sections for basic patient information, history, physical exam, review of systems, and other pertinent information (all in Spanish, of course). Upon completing the form it can be saved to the computer and/or printed. In our opinion, the most important aspect of the initial version of the software is that it allows the user to do everything that paper records permit, including the quick recording, editing, and finding of information, while hopefuly reducing the time required to produce each medical record. As subsequent versions are produced, more and more features will be added.

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During the rest of the week we plan on spending much time in Totonicapan Hospital learning how the hospital operates and currently keeps medical records. Much of this information was already collected during last years project, but we feel it is important that we are exposed, first-hand, to the hospital environment before we begin the gradual implementation of the SABER EMR software. We will also be interviewing and observing the medical students responsible for medical records and the doctors in order to determine their thoughts and concerns related to the transition to electronic records.

Arrival at Juan Flores Hospital, Totonicopán
At 6:45AM we piled into an SUV on the east side of el parque central and to make the approximately forty minute journey to the hospital. Dr.  Arturo Sajquim had been generous enough to offer us a ride to and from the hospital. Over the next two days we were able to observe two operations performed by Dr. Sajquim, meet some of the medical students and other hospital staff with whom we would be working, and explore the hospital to get a feel for the workflow in this environment. It was immediately apparent that many of the resources we take for granted in a similar setting in the U.S. (scrubs, gloves, etc.) were not so freely available. The ER, though only 9 beds,  was as busy as any  I had ever entered and the laboratory was just a couple of rooms with an incubator, autoclave, two microscopes, two bench-top centrifuges and a flow cytometer.  Despite the size of the hospital, the scores of Guatemalans waiting outside its doors as we made our way back to Dr. Sajquim’s car certainly illustrates its importance to Totonicopán and the surrounding community.
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Rolling out SABER 1.0

The past few days we have been testing out the initial version of SABER in the Totonicapan Hospital emergency department. To begin, we had to set-up all the hardware required to run our system. We brought with us a cart and placed upon it a desktop computer, printer, and router to serve as the center of the local area network for the EMR system. Dra. Lopez found a corner of the emergency department for us to store the cart. We also brought two notebook computers that we connected to the network and have been using to enter the data into the patient records. So far all of the hardware we brought has worked very well without any major issues.

Entering in the first few patient records was an exciting and rewarding process. Since we want to make sure the adoption of SABER goes as smoothly as possible, we have been slowly testing out entering patient data to the system. For our first several records, we shadowed medical students in the emergency department and entered data into the EMR system as the students produced the standard paper records they have been using.  During this process we have found several small improvements that we have requested Roberto make to the SABER software. For example, our initial system asked for the patients date of birth, but we found that most of the medical students ask each patient his or her age instead of date of birth. Thus, we decided to add an option to SABER that allows for input of an age or date of birth. Our slow introduction of the EMR has allowed us to identify minor issues such as this one, and hopefully will allow the medical students and doctors to easily and willful adopt the new system.

One issue we have yet to resolve is how to best secure the computer hardware against any potential theft. Dra. Lopez has mentioned that she is worried about the security of the cart containing the computer, printer and router. For the past several days, we have been storing the cart in a secure closet or room outside of the ER before we leave the hospital each day. However, this is slightly inconvenient as we have to set-up the system anew each morning. In order to address this problem we have been considering chaining each piece of hardware to the wall or even building a cage around the cart. We hope to have a find a solution to this issue within the next week.

Data collection and user feedback

After our initial round of SABER 1.0 training with the medical students, we began to collective user feedback and stratify our data collection methods. Based on the number of times a student had completed a patient record in SABER we separated users into expert users, defined as more than six entries, and new users and distributed a questionnaire with questions pertaining to their experience using SABER, the advantages and disadvantages they envision if/when the hospital begins to use SABER exclusively rather than patient records and what changes or suggestions they have to make SABER the most effective patient data collection and retrieval tool possible for them in their particular health care setting.

Additionally, it has been apparent that the amount of information that is collected when filling out the patient record in SABER 1.0 is greater than when filling out the patient record using the existing paper form and the use of SABER may aid in increasing the completeness of each patient record.

-John Baker and Korey Marshall


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