INTEROPERABILITY MODEL FOR ELECTRONIC MEDICAL RECORDS END TO END IMPLEMENTATION

Abstract

The adoption and utilization of Electronic Health Records can address numerous patient care difficulties and facilitate a paperless environment in hospitals; nevertheless, their full potential remains underexploited due to significant interoperability challenges. Patients typically pursue healthcare services from diverse providers operating inside either affiliated or independent organizations. In the absence of a consistent linkage across various healthcare providers, patient medical information becomes fragmented, incomplete, and obsolete. Numerous health institutions in Kenya have adopted EHRs/EMRs; nonetheless, both the nation and the facilities that have automated their records suffer from inadequate data convergence due to interoperability challenges among the various EHR systems. The interoperability of EHRs, a complicated and challenging undertaking, is predominantly lacking in poor countries. The identified target audience encounters these problems, along with architectural and technological obstacles, in facilitating seamless communication across EHRs. The study’s main objective was achieved through four specific objectives as follows; to establish EMR services available, their utilization, level of integration in the health sector; to determine the various EMR systems state of interoperability; to determine the strategies that have been used by successful implementers to address interoperability challenges and to develop an interoperability model for EMR implementation. The researcher scrutinized the following frameworks and theories to identify their weaknesses, and thereby guide the development of the interoperability model for EMR implementation: the European Interoperability Framework (EIF), Social technical systems theory, Luhmann's Social Systems Theory and Lopez and Blobel's Interoperability Framework. To underpin the study, the researcher adopted a pragmatic philosophical standing point to guide the researcher’s worldview of the research. Further a deductive and inductive approaches were also adopted for the purpose of triangulation of data. The study population included 229 healthcare workers from which a sample of 184 respondents were obtained using stratified and simple random sampling. Key informant interviews and structured questionnaires were used to gather data. Descriptive and inferential statistics were used to analyze and evaluate the quantitative data, while thematic analysis was used for analyzing the qualitative data. The findings of the study indicate technical interoperability (p=0.000<0.05), social interoperability (p=0.006<0.05), organizational interoperability (p=0.000<0.05) and semantic interoperability (p=0.000<0.05) and legal interoperability (p=0.002<0.05) were significant predictors. From the results of the study, a model of Electronic Medical Records End to End Implementation was formulated. The study concluded that technical, social, organizational, semantic and legal, factors must be addressed to achieve interoperability of EMR end to end implementation. From the findings it is recommended that challenges such as privacy concerns, implementation costs issues must also be addressed to fully harness the benefits of EMR interoperability. The facilities to invest on security measures, capacity building, compliance to government regulation, technology as strategies to address interoperability challenges. The model developed is a basis upon which future implementation of EMR interoperability end to end implementation can be based.