Executive summary
During the year 2008, the government of Jamaica decided to remove the fees on the health sector for the users, which has increased the rate of demand on the healthcare services by the citizens.
The ministry of health in Jamaica is also trying to restructure the processes within the health sector to improve its services to the citizens, enhance service delivery and increase the accessibility as well as accountability in the management system of the health services.
The use of electronic medical record (EMR) also known as electronic healthcare record (EHR) is a data collection document that records the digital data of medical reports for the patients.
In addition, it shares the information with other healthcare doctors as well as providing personal health reports for patients to present to their doctors when required. This technology of recording the patient’s information is seen as a way of improving the services offered in healthcare facilities.
This has been adopted by countries like United States and others are on the process of implementing it. Jamaica is one of the countries, which has also planned to implement the technology to improve the health services.
Introduction
Jamaica is the largest English-speaking Caribbean Island in its advanced stages to improve the health system, which is reflected by a decreased fertility and mortality rates in the country.
The maternal mortality rate in Jamaica has been high due to high rate of abortion done by girls and due to poor services in the maternal section but government has tried to improve its operations to curb the situation (Planning Institute of Jamaica, 2007).
The National Health Services Act in Jamaica divided the country into four health regions whereby each region is governed by the regional health authority. The regional authority has the mandate of ensuring that public health services are delivered to the citizens within the region.
The delivery of the health services is availed through the network of the secondary or tertiary care facilities and the primary care facilities, which are managed by the regional authorities in the country (Jamaica Ministry of Health, 2005).
The main aim of the research is to discuss the deficiencies in the health system of Jamaica and the benefits the country will achieve in adopting the EMR/EHR in operating its healthcare facilities.
The study tackles the challenges related to handling health information, medical products and technology, service delivery, health workforce, health financing and leadership and governance.
The research looks at the benefits that the country is likely to achieve in implementing the electronic medical record in the health system as well as some of the challenges the country might face in implementing the technology (Planning Institute of Jamaica, 2010).
Health information
The health information system in Jamaica is fragmented that there is no policy on health information system to govern the communication processes within the health system.
The country has always lacked data to carry out the statistical analysis in the health sector that it has always used the 1993 data to estimate the vital statistics in the subsequent years in preparing the health reports (Ministry of health, 2008).
In the year 2005 audit of the vital statistics, it was noted that in the health sector there was lack of communication and coordination between the government and the health agencies, which has made it hard for the government to plan accurately on how to improve the health system.
The government should therefore strengthen its national regulatory bodies governing the sharing of the health information between the public and the private sectors (World Health Organization, 2006).
Medical products and technology
Drug production in Jamaica proves to be limited due to the limited raw material imported for the production of the drugs. The country therefore depends heavily on the imported drugs and this increases the prices especially to the end user.
The government has therefore experienced increased costs in the health sector especially in the pharmaceutical service, which is the most utilized section and regularly accessed by the public due to the removal of the user fee in the health system (Ministers of Health of the Americas, 2007).
Service delivery
The authority in the four regions within the country monitors the delivery of services in Jamaica. The health services are therefore provided through a network between the primary care facilities and the secondary/tertiary care facilities within the region.
The distribution of services is high in urban areas as compared to rural areas where the healthcare facilities are few. The public sector in the country provides 95% of the services to the citizens.
The private sector provides the 5% and its services are rendered by the professionals in the public sector who own the private health facilities (Ross, 2009).
The quality assurance in Jamaica is under the various departments within the ministry of health and this result to a fragmented process. The country has therefore a goal for the year 2015 where it plans to achieve effective operations in the clinical processes within the four regions of operation.
The government needs to improve the delivery of services in the regions as well as develop a policy to guide its implementation (Planning Institute of Jamaica, 2007).
Health workforce
The study shows that the human resource in the health sector is not sufficient to serve the public. It was therefore noted that the distribution of the workforce in the regions is not equal because some regions are poorly served.
The study indicates that the dentists, doctors, midwives and nurses in the public sector are very few that the ratio at which they serve the public is 12.1/10,000 populations approximately.
In additional to this kind of shortage there is also inadequate number of rehabilitation experts in the occupational therapy and in speech (Ministry of health, 2008).
Leadership and governance
In the year 1997, the government channeled most of its energy in reforming the health sector by decentralizing the healthcare services to its four regions within the country and strengthening the ministry of health to be steering the four regions.
In the year 2003 evaluation, it was revealed that the government had not achieved its targets fully in health planning, transparency, service delivery, community involvement and accountability by the management (Ministers of Health of the Americas, 2007).
In the year 2009, the country had achieved some of its targets but still there are some weaknesses in areas of communication, service delivery and quality assurance.
The government is therefore trying to involve the society in the health planning as well as the delivery of services since there are greater opportunities the government is likely to gain.
The involvement of the church in educating the public about some of the diseases like HIV or any other chronic disease will help in improving the lifestyles of the citizens (World Health Organization, 2006).
Health financing
Research shows that the human resource expenditure in the year 2004/2005 increased to 82.6% of the total expenditure of the regional health authorities as compared to the previous expenditure, which was 79.3%.
The health financing programs by the government of Jamaica has not been successful due to poor performance in the economic sector, which is greatly affected by the fiscal constraints ((World Health Organization, 2001).
As much as the government has tried to settle the public debts, it has still not managed to maintain or expand the resources allocated to the health sector. In the analysis the expenditure incurred by the government in the health sector in the years 1992 to 2006 fluctuated by $70 per capital, which is equal to 2.3% GDP.
Research shows that due to the abolition of the user fee in the healthcare system the government is likely to incur an increased expenditure, which is estimated as US$44 million though at a constant rate.
The government is therefore expected to meet 52% of the expenditures as the remaining amount is collected from the revenues from the granting of casino licenses.
The study shows that the government is still unable to meet the expenses in the health sector as planned in the year 2015 target (United Nations, 2006).
Electronic medical records
The government of Jamaica is likely to implement the use of modern technology devices in its health system as planned in the year 2030 strategic plan. The electronic medical records have proved to be beneficial to the patients, healthcare providers as well as the government of the country that uses the EMR.
As compared to the paper records electronic medical records proves to be having many benefits such as security, privacy, easy accessibility of the files, financial benefits, accuracy in the clinical processes and administration as well as management benefits (Hayden, Maccurtain, Richards, Roche & Sahm, 2009).
Privacy and security
The health insurance portability and accountability act in the federal law requires that privacy should be maintained in the health sector. The information of the patients should not be revealed to any other person except the doctor or any other healthcare provider who will be attending the patient.
The technology of recording digital data in the health sector will enhance privacy due to different levels of accessing the information by the governmental agencies as well as the individuals (Curioso & Kurth, 2008).
The storage of digital data is durable and easy to trace for analysis as compared to the paper records where information can be erased or altered easily. The government of Jamaica is therefore likely to benefit by accessing the health information for the statistical analysis.
This is because it has been encountering challenges in tracing the required data during the analysis of the health matters for it to plan effectively. The citizens of Jamaica will also be guaranteed security of their medical reports as well as accuracy in the data presented for the administering of drugs.
This will also reduce the mortality cases related to maternal care since information will be clear in the files for the doctors to be able to assist (Ministry of health, 2009).
Improved clinical services for quality assurance
The implementation of electronic medical records improves the quality of the services offered to the patients.
The digital data help nurses to be more efficient in offering their services to the patients since the information presented to them by the doctors is clear compared to paper records where the nurse might fail to understand or read the information given correctly.
In most cases, this results to guess work where the nurses give different instructions from the doctor’s prescriptions (Planning Institute of Jamaica, 2010).
The use of electronic medical records will also reduce cases of redundant lab tests. In the paper work, doctors may fail to interpret the results submitted by the lab technicians due to illegibility of the writings and doctors end up giving wrong prescriptions to the patients.
The digital records help doctors to have an overview of the previous medication administered to the patients to understand the necessary changes to be made on the prescription of the drugs.
The use of digital data will also help the doctors to diagnose the disease through the list of symptoms provided in the document of the patient (Ministry of health, 2009).
The government of Jamaica will therefore achieve its goal in the year 2030 vision of quality assurance if it implements the use of this technology in the healthcare system.
The healthcare providers in the four regions will therefore avail services of high quality to the patients in terms of prescription of the drugs, dosage issued, medical lab tests and the interpretation of the lab tests.
This will help in reducing the costs of overused drugs as well as the mortality rate in the country (Ross, 2009).
Information integration
Through the implementation of the electronic medical recording, the sharing of information becomes easy since it is transferred electronically within the shortest time possible.
Doctors will therefore share the relevant information about the patients, which will facilitate quick service (Hanauer, Laffel, Laffel & Wentzell, 2009). This sharing of information will save patients the energy of travelling long distances for instance if one needs to see a specialist who is far.
The doctor attending him/her can send the required results to the specialists for the prescription of the drugs.
This will help the Jamaican government to reduce the costs in the health sector since the users do not incur the expenditures of medication (Hayden et al., 2009).
The patient internet portal, which can be devised through the implementation of the electronic medical records, will help the patients to learn the updated information about the healthcare services.
The citizens will therefore know the plans of the government in improving the health system and some of the contributions the government expects from them.
Through this process of sharing information, the government will achieve its target in involving the citizens in its planning (Curioso & Kurth, 2008).
Research purposes
The implementation of the electronic medical records will facilitate easy way of carrying out research. The information can be shared easily between the ministry of health and the relevant agencies to carry out the research.
This can be beneficial to the government since through research information about the possible ways of controlling some diseases can be devised as well as provide information to the government for easy planning on the future of the health system (Corson, 2009).
Reduction of the financial costs
As much as the implementation process of the electronic medical records may seem to be costly, the country is likely to benefit more after its implementation by cutting down the costs related to health.
Digital data records saves time in tracing the information for the patients, which enables doctors to attend many patients as compared to the traditional way of recording the information.
The healthcare facilities are likely to save the amount of money used in purchasing the papers and reduce the space of storage since the hard drives will occupy less space (Ministry of health, 2009).
The Jamaican government will reduce the cost of expenditure in its health system. Through the studies, analysis shows that the government incurs expenses in the pharmaceutical section and this can be cut down through the implementation of the EMR.
This is possible because the billing of drugs is easy in electronic data and this will help doctors to provide lists of generic drugs to the patients.
The knowledge on different drugs helps to save money hence reducing the heath costs incurred by the government (Ministry of health, 2008).
Estimated costs with and without the implementation of the technology in Jamaica
The government of Jamaica has been spending low as compared to other countries in the Caribbean. The government removed the medical expenses on the users of the facilities in the year 2008 for its citizens to access the facilities easily and conveniently.
This will improve the health system to achieve the 2015 goals in the health sector. In its strategic planning of the year 2009 to achieve the 2030 vision the government aims at improving its health services as well as cutting down the expenses related to healthcare (Planning Institute of Jamaica, 2010).
Study shows that the health system and services budget for the year 2006/2007 biennium was $995,860, which reduced to $911,000 in the 2008-2009 budgets.
During the strategic planning for the year 2030 vision the country plans to lower the costs for the country to be able to expand its services to the public.
Research shows that the implementation of the electronic medical records will therefore reduce the costs by 10% in the first year after its implementation, 20% in the second year and 35% in the third year (World Health Organization, 2008).
Research shows that the estimated value of implementing an EMR per physician is approximately $33,000 and the licensing ranges from $1,000-$25,000 while the full licensing is approximately $10,000.
The implementation fee of the EMR is usually billed per hour where one hour is approximately $75-$150 while the time of implementation is 35 hours approximately.
The network hardware costs and configurations depend on the type of the server as well as the workstations (Ministers of Health of the Americas, 2007).
Conclusion
Through the adoption of the electronic medical records by the government of Jamaica in running its health system, the country is likely to achieve more benefits at earlier stage than the projected vision of the year 2030.
The government will be able to manage risks in the health system like reducing non-clinical time and increasing time for doctors to attend the patients as well as improve the quality of services in healthcare facilities.
The government will attain administrative and management benefits related to accountability and transparency, which has been a problem in the health system of Jamaica for a long period.
The government will reduce its expenditure in the healthcare especially in the pharmaceutical section where there is an increased number of users hence increased expenses.
The Jamaican government should therefore utilize the opportunity of implementing the technology to be effective in planning due to the availability of the information and improve the quality of the services rendered to the public as well as improve the lifestyle of the public.
Through improved lifestyle and reduced costs in the health sector, the government of Jamaica will improve its economy as well as standards of living.
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