1. Health Professionals’ Readiness to Implement Electronic Medical Record System at EYGH
Pyae Sone Htoo1, Thida Aung2, Khay Mar Mya2, Kyawt San Lwin2
1Department of Medical Service, Naypyitaw
2University of Public Health, Yangon
Oral Presentation: Dr. Pyae Sone Htoo

2. Introduction
Different healthcare information systems are being implemented with better data management, communication and decision making
EMR is the priority agenda in developed as well as many developing countries
More than 50% of EMR fail to be properly utilized in the world (Biruk et al., 2014)
The key cause is lack of pre-implementation activities like resource and organization readiness which can facilitate the successful system implementation

3. Justification
With increased utilization of healthcare services during last years, MoHS is trying to develop an electronic HIS including EMR for hospitals
In the phase of pre-implementation, assessing user resistance for a new system could have beneficial for successful adaptation
Assessing the level of readiness of healthcare professional for EMR in front line hospital is essential before the actual implementation of it
To implement EMR system nationwide, the readiness of health professionals for the system at all level of hospitals is needed to be assessed.

4. Objectives General Objective
To asses the readiness of health professionals to implement electronic medical record system at East Yangon General Hospital
Specific Objectives
To assess the computer and information communication technology literacy and usage among health professionals
To assess the knowledge on electronic medical record system among health professionals
To determine the core and engagement readiness to implement electronic medical record system
To find out the factors associated with the health professionals’ readiness to implement electronic medical record system

5. Research Methodology
Study design - Hospital based cross-sectional comparative study
Study period - Sept-Dec 2017
Study area - East Yangon General Hospital
Study Population - All doctors and nurses with > 6 months of total service duration at EYGH

6. Research Methodology (cont.)
Sample Size and Sampling Method
With the assumption of difference in proportion of overall readiness for EMR between doctors and nurses as 25% at 95% confidence with 80% power

7. Research Methodology (cont.)
Sample Size and Sampling Method
Therefore, total 104 participants at 1:1.5 ratio were needed. Finally, total 119 respondents, 49 doctors and 70 nurses were participated in this study.
The sample was drawn by simple random sampling method with computer generated random number.

8. Research Methodology (cont.)
Data Collection Method
The Semi-structured questionnaires containing 5 sections are developed
Pre-test was done at WYGH
Validity/Reliability test and revision and edition of questionnaires was done after pre-test
Data collection with edited semi-structured Myanmar questionnaire by face-to-face interview with doctors and nurses at EYGH

9. Data Management and Analysis
Data entry - by Epi-Data version 3.1software
Analysis - SPSS 16.0 software
- α was set at 0.05 for statistical significant

10. Findings

11. Age of Respondents (n=119)
Back to back

12. Sex (n=119)
Back to back

13. Highest Educational Level (n=119)
Back to back

14. Total Duration of Service year (n=119)
Back to back OR bar

15. Using Smart phones/Tablets and Computer

16. Purpose of Computer Used (n=87)
Back to back

17. Self-recognized Level of Knowledge about EMR System
100% streak bar

18. Knowledge about ICD-10 Code (n=119)
100% stack bar

20. Knowledge Score on EMR system among Doctors and Nurses (n=119)
Computer and ICT Literacy score among Doctors and Nurses (n=119)
Type of Profession
Number
Mean SD t
p-value
Doctor
Nurse 49 70
25.35
11.79
6.86
8.04
9.608
< 0.001
Knowledge Score on EMR system among Doctors and Nurses (n=119)
Type of Profession
Number
Mean SD t
p-value
Doctor
Nurse 49 70
11.41
8.2
3.44
3.6
4.871
< 0.001

21. Readiness for EMR system
Core readiness - the expressed dissatisfaction with the current way of paper based record system
Engagement readiness - the attitude on potential negative impacts, recognition of benefits and willingness to accept EMR
Overall readiness - the intersection of core and engagement readiness

22. Readiness for EMR System (n = 119)
Doctors
Nurses

23. Overall readiness to implement EMR system
Association of Knowledge level and Overall Readiness for EMR System (n=119)
Knowledge level of EMR
Overall readiness to implement EMR system
Doctor (n=49)
Nurse (n=70)
Total (n=119)
Low 10
(38.5%) 23
(40.4%) 33
(39.8%)
High 12
(52.2%) 11
(84.6%)
(63.9%)
Total 22
(44.9%) 34
(48.6%) 56
(47.1%) X2
0.928
8.303
5.868
p-value
0.336
0.004**
0.015*
* Scientifically significant level at p < 0.05
** Scientifically significant level at p < 0.01

24. Discussion
58 (48.7%) were low knowledge and 61 (51.3%) were high knowledge level on EMR system comparing with the study of HabibiKoolaee et al., 51.2% of respondents had good knowledge about EMR and their result was similar to this study
Regarding overall readiness was (47.1%) among 119 respondents compared to the study by Biruk et al. which reported that (54.1%)

25. Discussion (cont.)
In this study, the level of computer and ICT literacy, presence of computer at home and presence of access to computer at workplace were not significantly associated with the overall readiness for EMR system
Biruk et al. in 2014 revealed computer literates, presence of computer at home and access to computer at home were more likely to be ready than their counterparts respectively

26. Discussion (cont.)
Health professionals who had good knowledge on EMR system were more likely to be ready for EMR system as compared to health professionals with poor knowledge which is similar result revealed in the study in Ethiopia
This may be due to the fact that health professionals who have good knowledge may have the tendency to accept the advantage of technology and to be likely to be ready for EMR system.

27. Limitations of the Study
Focused only on the readiness of health professional towards EMR and other aspects of readiness such as technology and societal readiness were not coped
Level of English language skill and ICT literacy were self-reported and actual level of skill and knowledge could not be assessed
There might be some information bias because it could be biased by social desirability.

28. Conclusion
Overall readiness for EMR system was not statistically different between Doctors and Nurses and
Overall readiness was regarded as low compared to the other international studies

29. Recommendations
Teaching programmes for computer and knowledge on EMR system should be incorporated into the curriculum of medical education and nursing education
In-service training programmes and pilot study related to ICT and EMR system should be done
Before full implementation of EMR system, there should be a hybrid system of paper and computer to become ease with technology and to have more understanding of the benefits of technology

30. References
Abu Raddaha, A. H. Nurses’ perceptions about and confidence in using an electronic medical record system. Proc. Singap. Healthc.
Adjorlolo, S. & Ellingsen, G. Readiness assessment for implementation of electronic patient record in Ghana: a case of university of Ghana hospital. J. Health Inform. Dev. Ctries. 7, (2013).
Biruk, S., Yilma, T., Andualem, M. & Tilahun, B. Health Professionals’ readiness to implement electronic medical record system at three hospitals in Ethiopia: a cross sectional study. BMC Med. Inform. Decis. Mak. 14, 115 (2014).
HabibiKoolaee, M., Safdari, R. & Bouraghi, H. Nurses Readiness and Electronic Health Records. Acta Inform. Medica 23, 105 (2015).

31. THANK YOU