The 17th National Health Research Forum for Action

Department of Health - Health Policy Development and Planning Bureau

Knowledge, Attitudes, and Practices of Selected Regions in the

Philippines on Electronic Medical Record System

Renerio Q. Cordova Jr., Emanuel Y. Gloria, Jennilyn S. Ygaña

Background
Electronic Medical Records (EMRs) are digital versions of the traditional paper-based health
records systems with the added benefit of improved data security, interoperability, and faster
data transmissions within one organization1. The Department of Health (DOH) has adopted
an eHealth Framework aimed at improving healthcare delivery through the use of EMRs and
Health Information Systems. To accomplish this, the DOH has been accrediting EMR
systems developers and providers to engage Local Governments and implement the systems
in Rural Health Units. Despite these efforts, EMR implementation is still at 72.27% (1,871 of
2,589)2. Moreover, reasons for the low implementation is not well established in literature.
Related studies associated with EMR in the Philippines is primarily citations of systems
(Ridad et al., 2017; Paulmano & Estuar, 2016; Batangan, 2016; Batangan, 2014), database
utilization (Cañizares, 2018), service quality measurement (Jiang et al., 2012), and perceived
benefits (Canlas et al., n.d.). Furthermore, only a few studies tackle EMR implementation
(Ongkeko et al., 2016; Premji et al., 2012).

Main Thesis Question

Given this background, the research question of this study inquires on what is the current
scenario of the EMR system implementation in primary care facilities? Thus, the main
objective of this study is to capture and describe current EMR implementation of primary
healthcare facilities and its latent factors in the context of Knowledge, Attitude, and Practice
(KAP).

Methodology
The study utilized a qualitative research design. The population in this study considered all
government primary healthcare facilities (Rural Health Units (RHUs)) engaged in EMR,
specifically the head of the EMR team or in-charge. The locations visited and participants
were based on convenience and availability during the field monitoring visit of the Health
Sector Performance Monitoring Unit from April – June 2018. Data collection was done
through Key Informant Interviews using a semi-structured questionnaire. The interviews
were conducted in the participants’ respective RHUs and each interview lasted from 30-50
minutes. Data from the interview was transcribed and encoded in Microsoft Excel. After

1
National Alliance for Health Information Technology. (2008, April 28). Report to the office of the National Coordinator for Health
Information Technology on defining key health information technology terms [Electronic Version]. Washington (DC): National Coordinator
for Health Information Technology. Pp. 1-40. Retrieved August 23, 2018 from http://www.hitechanswers.net/wp-
content/uploads/2013/05/NAHIT-Definitions2008.pdf
2
Department of Health. List of EMR Implementing Sites as of May 31, 2018.
which, a Thematic Analysis was performed, and thematic maps were produced using
Freemind software.

Results:
A total of 28 participants were interviewed coming from Region VI, IX, XII and XIII.
Majority of these participants and their health facilities are utilizing iClinicsys. The
demographics of these participants is shown in Table 1.

Table 1. Demographics
Sex Age Highest Educational Attainment Job Status

Between Between Between

Master's College Job-
Male Female 20-34 35-49 50-64 Vocational/Technical Plantilla Casual
degree graduate Order
years old years old years old

25.00% 75.00% 67.86% 28.57% 3.57% 7.14% 64.29% 28.57% 28.57% 35.71% 35.71%

Participant Recorded
EMR Trained Public Health Experience Computer Experience
Interviews

Yes No Yes No ≤ 5 Years 6-10 Years ≥ 11 Years Minimal Moderate Advanced

92.86% 7.14% 89.29% 10.71% 60.71% 32.14% 7.14% 7.14% 75.00% 17.86%

The current scenario of the EMR implementation is captured into three categories:
Knowledge, Attitude, and Practice. For each theme, results are shown in an overall thematic
map.

Knowledge. The theme similar across most regions (at least 3 of 4) for “Knowledge” shows
the following: What is an EMRS?, source of information, and EMRS Variants. The thematic
map for this category is shown in Figure 1. The aforementioned themes describes what is an
EMRS, where the respondents got most of their information on EMRS, and types of EMRS
they know.

Fig. 1. Thematic map on Knowledge.

Attitude. Similar themes across most regions (at least 3 of 4) for “Attitude” shows the
following: EMRS Preference, Positive Feedback of EMRS Transition Plan, Positive and
Negative Effects of EMRS at Work, and Issues of EMRS Use. These themes are defined as to
the respondents’ preference on EMR; positive feedbacks towards the EMR transition plan;
the effects of EMRS at work both positive and negative; and their issues on EMRS use,
respectively. These themes are illustrated in Figure 2. Note that three themes shows no
general codes due to the variation of responses within regions.

Fig. 2. Thematic map on Attitude.

Practice. Similar Practices across most regions (at least 3 of 4) is shown in the following
themes: Challenges, Operations, Primary Work, Utilization. These themes are illustrated in a
thematic map shown in Figure 3. These themes are defined to as the issues experienced by
the regions; how operations are currently on-going; what is the primary task of the encoders;
and how is EMRS being utilized, respectively.

Fig. 3. Thematic map on Practice.

Conclusion
Each region has a unique KAP pattern, and even across health facilities. In general, the latent
factors in the implementation of EMRS of primary care facilities in terms of KAP show that
knowledge is mostly focused on a type/s of EMRS and is obtained through both informal and
formal sources. Attitudes towards EMR highlights respondent preference to fast look-up and
agreeable attitude towards the EMRS transition plan. Current practices in the use of EMR
show that traditional paper-based encoding is still present resulting in redundant data
encoding.

Recommendations
EMR implementation is going to play a huge role in the success of the eHealth program.
Thus, the study recommends the following:
● EMR design and implementation plans should be revisited to account for gaps in
knowledge, Conditional advocacy for EMR, redundant encoding practices, and
various issues on EMR System and experience; And
● Conduct further studies that can capture EMR implementation and adoption.