REACTION TO AN ARTICLE

DEVELOPMENT OF MOBILE ELECTRONIC HEALTH

RECORDS APPLICATION IN A SECONDARY GENERAL
HOSPITAL IN KOREA

TO IMPROVE QUALITY IN HELATH CARE

The large number of people who are currently receiving treatment at several
health service agencies has made the reason for the importance of Health Information
Management activities. This is because someone might do a medical check-up at a
hospital in another city or take medication abroad. The idea of managing patient
health information is actually not new. Around us, especially in Indonesia, many
health service agencies have managed patient health information by storing lab results
data, archives about medicine and others. However, the data is only managed in each
institution in the form of a paper-based conventional record.
Technological developments provide many contributions to improve health
services provided to patients more effectively. Including in health information
management activities, several health service agencies have begun to implement
health information systems electronically so that management of patient health data
can be carried out more effectively. Some hospitals have also transferred the media of
patient health data from paper forms to digital format. They also began making
Electronic Health Record (EHR) records that contained patient demographic data,
medical history and medication, diagnostic information, vital signs, history health,
laboratory data, and radiology reports. What is unfortunate is that information cannot
be opened to other health service institutions, because the patient health information
management system is only carried out independently, at each health service agency.
Health Information Management actually aims to collect, store and make
patient health information is available and easily accessible when needed. So that
HIM can help health care workers in providing health services to patients better. On
this basis the management of integrated patient health information is important, in
order to facilitate several medical service providers in exchange activities and share

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patient health information. As stated by WHO that an electronic health system must
be built to facilitate the exchange of data. In addition, patient health information
available must be able to be served with an information system, so that people in need
do not need to come directly to the place of data management agency. The existence
of a health information system that provides access to patient data in a digital format,
is expected to enable medical staff to track patient data over time, helping to find out
how the patient is and improve the quality of health services. patient health done
electronically and integrated can help every health care worker in providing health
care activities to patients better.
Why I am interested in an article about “Development of Mobile Electronic Health
Records Application in a Secondary General Hospital in Korea”?
Actually the article has been around for a long time since 2013, and continues to
development until now where patients may have been able to access their health data
without having to come to the hospital because it became one of their goals.
I am interested because at the hospital we have not implemented an integrated
electronic system in each hospital service unit. For example: we have started by
recording electronic patient data but are still limited to medical records. This makes
the medical record officers overwhelmed and paper-based patient data accumulates in
the medical record room. The other hand that many complaints arise related to the
service system in each unit that is too long. I am also interested because of the
obstacles faced by Secondary General Korean Hospitals when developing EHR,
almost the same as experienced in our hospitals.
Therefore, I chose this article as a reference for me in an effort to improve the
quality of services in the hospital where I work. Below is an example of Root Cause
Analysis and a follow-up “Plan” in an effort to improve the quality of hospital
services related to the use of technology and information currently developing.

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 ROOT CAUSE ANALYSIS

STEP 1: DETERMINE THE INCIDENT

Out Patients Complaining Because Of Waiting for Too Long in The Admission.

STEP 2: DETERMINE THE TEAM

Investigator’s Team :

1. Chair of Quality Hospital Services

2. Outpatient Clinic Coordinator

STEP 3: COLLECT DATA AND INFORMATION

I. Data : Chronology of The Incidence of Patients Complains

II. Interview :
Done to:
a. Admission officer
b. Nurses on duty at the time of incident
c. Patient the one who complain
III. Direct Observation in the Outpatient Care Admission.

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 STEP 4: CHRONOLOGY INCIDENT FORM / TABULAR TIMELINE

February 14, 2019

Time 07.30 Am 08.30 Am 08.35 Pm 08.40Am 09.05 Am 09.10 Am

Incident - Patients come - Patient registered The Officers - The officer Patient was The officer
to outpatient - Registration officer searched patient searched angry and was late
clinics. asked the patient’s electronic health patient threated not to finding the
- Patient in line identity card. records and found paper health come to the patient’s paper
to registration. the patient’s number. record. clinic anymore. health records.
Additional Patient forgot to
Information bring Patient’s
Identity Card.
Good Practice - - Another officer asked apologized
- Keep being polite and friendly.
- The officer promised to
immediately notify the hospital
management.

STEP 5: PROBLEM IDENTIFICATION AND ANALIZYS

No. IDENTIFICATION TOOLS

1. Patient was angry and threated not to come to the clinic anymore. 5 Why

2. The officer was late finding the patient’s paper health records.
3. Patient forgot to bring Patient’s Identity Card.

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 1st Problem:

Who: Admission Officer

When: February 15, 2019
Where: Admission in the outpatient clinic
What: Patient was Angry and Threated not to Come to the Clinic
Anymore.
WHY 1 Because of a long wait
Why patient was angry and threated not to come to the
clinic anymore?
WHY 2 Because officer was still looking for paper based patient health
Why do patient wait long? record.
WHY 3 Because it can’t find.
Why officer was still looking for paper based patient
health record?
WHY 4 Because it’s to much and piles up.
Why it can’t find?
WHY 5 Because of the shape of paper.
Why it’s to much and piles up?
WHY 6 Because the computer is only in admission, other area service is
Why still use paper? none.
WHY 7 Maybe the hospital can’t afford it.
Why the computer is only in admission?
WHY 8 I don’t know
Why can’t hospital buy it?
Waiting too Long

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 2nd Problem:

Who: Admission Officer

When: February 15, 2019
Where: Admission in the outpatient clinic
What: The Officer was Late Finding the Patient’s Paper Health
Records.
WHY 1 Because it’s too much and piles up.
Why officer was late finding the patient’s paper health
record?
WHY 2 Because the place is not enough.
Why it’s piles up??
WHY 3 I don’t know.
Why is the place is not enough?
A Paper Based Patient Health Record need a large place.

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 3rd Problem:

Who: Admission Officer

When: February 15, 2019
Where: Admission in the outpatient clinic
What: Patient Was Forget to Bring Patient’s Identity Card.
WHY 1 Because doesn’t remember
Why do patients forget to bring cards?
WHY 2 Because it was removed from the wallet.
Why doesn’t remember?
WHY 3 Because it was full
Why it’s removed from the wallet?
WHY 4 Because there are too many cards
Why is the wallet full?
WHY 5 -
Why many cards?
The Patient has many Identity Cards so Forget.

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 FOLLOW UP PLAN TO SOLVE THE PROBLEMS
NO PLAN DO STUDY ACTION PIC

HUMAN

1 Add the medical - Recruitment The medical record There are no personnel HRD
record officer - Has posted officer is a competent applying.
according to the needs. advertisements staff for admission.
for it.
2 Pay attention to officer Make training plans Pay attention to 1. Recruiting medical HRD
qualifications for existing continuing education record staff: there
officers. and human resources is no applying yet.
development. 2. Training of
admission staff
officer has not
been implemented.
MACHINE

1. - Establish an - Is making a To improve the quality - Make an EHR Vice

integrated patient budget plan of effective and efficient proposal. General
health record services, integrated Facility
system throughout patient health record
the hospital. system is needed.

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 METHODS

1. Review the protocol Revise the protocol Update the protocol is - Will be revised as IT, Medical
as needed. important to guide soon as HER system Record
officers in their work. becomes available. Officer
MONEY

1. Prepare a budget for Make a budget Budget planning for - Already included in Finance
provide and provide and the proposal.
maintenance of the maintenance is
EHR system. important to ensure that
EHR system can
function properly.
MATERIAL/ MEDIA

1. Provide the necessary Buy the necessary - The availability of - Will be held if the Finance
equipment such as equipment the required proposal has been
printer, ink, paper, etc. according to the equipment influences approved.
needs. the improvement of
service quality.

Note:
If the proposal is not approved by the hospital managers then redesign.
For ex.: Submitting a proposal only for outpatient clinic, not throughout the hospital, using the same process.

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 CONCLUSION

Electronic health record systems have the potential to improve the quality of
health services primarily through the availability of health information.
Implementing EHR systems in healthcare facilities will certainly face obstacles or
barriers. The barriers identified in Secondary General Hospital in Korea were
categorized into the time too long, budget increases are too expensive and needed
support from the hospital management or stakeholder. Although many obstacles were
found, the hospital needs to implement EHR system to improve the quality in health
care.

Hopefully the simple example above can help to understand how to improve
quality in health care using Root Cause Analysis.

SPUM, February 13, 2019

MSN Student

Sr. Maria Bernadete Sea, SPC

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 REFERENCE

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3920044/

https://asq.org/quality-resources/dmaic

Hospital Accreditation Document

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