As indicated in previous scientific research, the use of EHRs with basic functionalities is prominent in oncology care facilities in both high and low-medium income countries.
The basic functionalities of EHRs does not include the patient’s electronic narrative records. For this reason, the use of narrative in EHRs to support the decision-making process was researched. This study was carried out in three private hospitals in Cape Town, South Africa.
The aim of the research was to explore the use of narratives in electronic health records to support the decision-making processes of healthcare professionals in private oncology care. To achieve the study aim, the researcher used the research philosophy, research method and research technique detailed below.
An interpretivist stance was best suited to this research study. This approach assumes that reality and knowledge are socially constructed. The output of this philosophy is always subjective which gave the researcher room to interpret the information according to her own understanding of the study.
The study was qualitative meaning nun-numerical data was collected with subjective interpretation based on how the researcher perceived the phenomenon from the participants’ perspective. The researcher engaged with scientific literature (secondary data) to acquire background information on the use of narratives in EHRs. Semi- structured interviews were used as a method of data collection. In this vein, primary data was elicited through a series of open-ended questions which enabled participants to freely express their opinions. The interview sessions were conducted in the participants’ place of work which they found most convenient and comfortable. This ensured participants felt at ease and confident which facilitated trust toward the researcher.
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There are several data collection methods such as surveys, observations, questionnaires and focus groups. These methods were not used since this study is descriptive in nature and not explorative. Through the use of one-on-one personal interviews, the researcher was able to derive a sense of voice, intonation and body language relevant to the answers participants were giving after each question. The responses were audio recorded to guarantee the accuracy of information, and some notes were taken in case the recording device malfunctioned. Although face-to-face interviews are suitable to this study, some challenges emerged. Obtaining additional information was difficult and it often diverted the context of the study. As result, the researcher concentrated predominantly on the pre-structured questions. On the other hand, there were time and cost constraints – traveling long distances and conducting comprehensive interviews were time consuming and costly, especially when interviews had to be rescheduled. Every participant in the study contributed to the research objectives, which were:
Ø To understand how the experiences of healthcare professionals, with the use of existing EHRs influence the outcome of their decision-making process
Ø To determine how narratives can be incorporated in electronic health records to aid the decision making process of healthcare professionals in oncology centres.
Ø To establish the requirements of incorporating narratives in electronic health records to support healthcare professionals in their decision-making.
Ø To understand the reasons why narratives are yet to be used to support decision making in oncology care.
The findings have shown that the use of EHRs is considerable in private oncology care centres. Hence, healthcare professionals have a high level of awareness of the usability of EHRs due to its performance and positive outcomes.
Findings further indicate that EHRs were adopted to redress the shortcomings of paper- based records in order to improve healthcare professionals’ work processes, and, in turn, enhance patient care. The evidence indicates convenient and simple sharing of information within and across several medical network services, easy accessibility and
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retrieval of information, and a reduction of data loss through backups. In other words, it is clear that the use of EHRs is of great importance in healthcare as its advantages are linked to the healthcare professionals’ work processes which impact the execution of decision-making. However, there is still a limited number of healthcare professionals that are reluctant to use EHRs due to culture, belief, values and their own expectations.
This often creates a gap in their care delivery. In fact, some participants mentioned that they resist change because they are not comfortable with embracing new technology even though training and information technology support is provided by the hospital management.
When the topic about patient narrative was introduced to participants, they displayed knowledge about patient written narratives. This, however, was limited to the diagnosis phase. Furthermore, participants had limited knowledge about electronic narratives (audio and video) in EHRs. Although healthcare professionals perceive using electronic narratives as an effective practice to enhance their service and expertise, they still experience challenges with the current system. The current EHR systems can only contain basic functionalities such as laboratory test results, images from radiology, allergy information and warnings, dates and schedules of patients’ immunisations, medications relevant to the patient, diagnoses of the patient, patient’s medical records, vital sign readings, progress notes, and patient demographics as well as billing and administrative data. There is a need to upgrade the current system for it to handle functionalities such as x-rays, and to retain and analyse patient electronic narrative records (audio and video).
This research study showed that there is a need for oncology care centres to have the proper infrastructure to make meaningful use of narratives in EHRs. Participants mentioned that there is concern around the financial impact of such an implementation.
This will not only affect healthcare management but patients as well since the cost of treatment will inflate. Other obstacles participants conveyed involved the training of healthcare professionals, information technology legislation, and consent documentation which all contribute to the cost of implementation Additional maintenance costs also need to be factored in after implementation. Cultural differences
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should be taken into consideration whenever a new system is implemented as people have opposing thoughts and backgrounds, and in some cultures there are certain medical practices that are unacceptable. This does not only involve patients but healthcare professionals as well as they too associate with certain cultures. Since EHRs contain crucial information about patients, security must be at the core of implementing any system or adding functionalities to EHRs. The use of narratives in oncology care is still in its infancy.
In summary, it is recommended that whenever a new system is implemented, EHR vendors must be consulted, and users must be part of the implementation process.