Computer Information Systems, Quinnipiac University, Hamden, CT, United States.
ASU Emeritus College, Arizona State University, Tempe, AZ, United States.
Int J Med Inform. 2019 Sep;129:430-437. doi: 10.1016/j.ijmedinf.2019.05.026. Epub 2019 Jun 3.
Electronic Health Records (EHRs) interventions hold the promise for enabling better healthcare. However, the implementation of EHR systems has been scarce in developing countries. The objective of this study is to investigate the state of EHRs implementation in Morocco; and draw insights for potential improvements.
University Medical Centers, known by locals in French as Centres Hospitalier Universitaires (CHU), are the largest and most advanced public healthcare centers in Morocco. A two-phase qualitative study was conducted in four out of the five CHUs. Phase One involved data collection through semi-structured interviews with 27 clinician champions, administrators, and medical directors. Phase Two included a brainstorming session during a health informatics conference held in Fes, Morocco. The data were analyzed using inductive analysis.
We identified five main categories of challenges due to silo strategies: (1) EHRs selection and weak bargaining power, (2) identical errors repeated across silos, (3) a lack of interoperability standards, (4) insufficient human and financial, and (5) missed cooperation and collaboration opportunities.
While identifying these silo challenges is an important milestone, proposing guidelines to address these challenges can bring Morocco and similar developing countries a step closer to improving healthcare through the use of health informatics and EHRs. Our recommendations for public healthcare organizations are threefold: (1) recognize the power of partnerships among all CHUs, (2) establish an e-health framework, and (3) seek national and international collaborations to drive and shape the eHealth agenda. Furthermore, we align our recommendations with the World Health Organization toolkit for an eHealth strategy to further benefit developing countries.
This study identifies the challenges faced by the Moroccan EHRs implementation silo-ed strategy, and it proposes practical and fundamental guidelines to address these challenges and develop an interoperable and sustainable national eHealth system in Morocco and similar developing countries.
电子健康记录（EHR）干预措施有望改善医疗保健。然而，在发展中国家，EHR 系统的实施却很少见。本研究旨在调查摩洛哥 EHR 实施的现状，并为潜在的改进提供见解。
被当地人用法语称为 Centres Hospitalier Universitaires（CHU）的大学医疗中心是摩洛哥最大和最先进的公立医疗中心。在五家 CHU 中的四家进行了两阶段定性研究。第一阶段通过对 27 名临床冠军、管理员和医疗主任进行半结构化访谈收集数据。第二阶段在摩洛哥非斯举行的一次健康信息学会议上进行了头脑风暴。使用归纳分析对数据进行分析。
我们发现由于筒仓策略存在五个主要类别的挑战：（1）EHR 选择和议价能力较弱，（2）筒仓之间重复出现相同的错误，（3）缺乏互操作性标准，（4）人力和财力不足，（5）错失合作机会。
虽然确定这些筒仓挑战是一个重要的里程碑，但提出解决这些挑战的指导方针可以使摩洛哥和类似的发展中国家通过使用健康信息学和 EHR 进一步改善医疗保健。我们对公共医疗组织的建议有三点：（1）认识到所有 CHU 之间合作的力量，（2）建立电子健康框架，（3）寻求国家和国际合作，推动和塑造电子健康议程。此外，我们将我们的建议与世界卫生组织的电子健康战略工具包进行了对齐，以进一步使发展中国家受益。
本研究确定了摩洛哥 EHR 实施筒仓策略面临的挑战，并提出了切实可行的基本指导方针，以解决这些挑战并在摩洛哥和类似发展中国家开发一个互操作和可持续的国家电子健康系统。
