Implementing a Large-scale Electronic Health Record System in the Primary Healthcare Centres in Saudi Arabia

Abstract

There is worldwide demand for the implementation of electronic health systems and a transformation to electronic transactions in healthcare organisations. This move to ehealth transformation stems from the perceived positive impact that e-health systems have in improving the quality of healthcare and, in turn, reducing expenses. Despite this, more than half of previous Electronic Health Record System (EHRS) implementation projects have failed due to several barriers and challenges. There has been no previous research that has explored the implementation of an EHRS in Primary Healthcare Centres (PHCs). In addition, barriers and facilitators to the implementation of large-scale EHRS in PHCs are not well defined and there is little known about the impact of Financial Resources (FR) and Centralised Management (CM) on such implementation. Thus, this thesis aims to explore the large-scale implementation of EHRS in PHCs in Saudi Arabia (SA). To achieve this aim, a mixed-methods approach comprising both quantitative and qualitative methods was adopted. Data were collected via questionnaire-based studies and semistructured interviews. Three different populations were targeted: project team members, PHC staff, and EHRS end-users. Descriptive and inferential statistics were applied to the quantitative data, and thematic analysis was used to analyse the qualitative data. The findings revealed high PHCs readiness at the organisational and individual level when compared with the technological level. Both FR and CM were documented to have a positive impact on the implementation of a large scale EHRS. Several facilitators to the implementation of the EHRS were identified, including: strong leadership and appropriate management, PHC specifications, system usability, perceived usefulness and efficiency. The scale of the project, shortage in Health Informatics (HI) expertise, lack of training and support, geographic challenges, software selection and end-user involvement were identified as the main barriers to implementing a large-scale EHRS in the PHCs. No relationships were detected between individual demographic differences, such as age and gender, and level of readiness or satisfaction. Based on the Saudi experience, there may be some important transferable lesson for similar projects elsewhere. Large-scale EHRS projects need to adopt CM. In addition, due to shortage in HI expertise, policymakers may need to carry out some consultations to formulate good implementation plane. Largescale projects also need to be implemented by more than one vendor and include training and technical support to increase end-user satisfaction. Inadequate infrastructure, lack of interoperability, changing executives and lack of technical support were the main possible causes to the failure of large-scale EHRS projects. Implementation needs to ensure sufficient budget and time have been allocated to mitigate the challenges identified. III DECLARATION

Barriers to the implementation of large-scale electronic health record systems in Primary Healthcare centers

“…Following each interview, participants were explicitly urged to voice any comments or concerns that were not discussed during the interview. The duration of the interviews ranged from 35 to 130 minutes, with an average duration of approximately 65 minutes [49].…”

“…Ultimately, due to our location in the UK, it was not feasible to physically disseminate the questionnaire. Thus, we opted to employ an online self-administered questionnaire through Survey Monkey to gather the data [49].…”

“…The questions were graded according to the degree of consensus, ranging from the highest to the lowest. The cumulative agreement was aggregated by combining the responses of "agree" and "strongly agree" in order to discern the relative levels of agreement among different items, hence facilitating their ranking [49].…”

“…All tests are non-parametric and were selected due to the data being categorized as ordinal and nominal. To assess the disparities among groups, we conducted Mann-Whitney U tests for two groups and Kruskal Wallis tests for three or more groups [49].…”

An examination of large-scale electronic health records implementation in Primary Healthcare Centers in Saudi Arabia: a qualitative study

“…The researcher would like to thank the Deanship of Scientific Research, Qassim University for funding the publication of this project. The majority of the content of this manuscript is quoted from the main author's PhD thesis entitled Implementing a Largescale Electronic Health Record System in the Primary Healthcare Centers in Saudi Arabia (69). The authors extend their appreciation to Dr. Mohammed Alwaheeb as inter-rater and checker of the analyzed data.…”