Accessing personal health records is seen as one of the most important tools for transforming a health information system (11). This study found that physicians reported a very positive impact of the introduction of an EHR into PHCs. However, the impact of using the EHR in patient care at chronic disease clinics within PHCs is still probably not achieving its full potential. The current EHR does not allow patients full access to their health information. Current research on patient portals has shown that they can significantly improve patients’ adherence to screening recommendations and their ability to self-manage their NCDs by increasing their involvement in their health and focusing conversations on setting goals; overall this has improved patient-centred care delivery and the quality of care (11-14). Other researchers have found that when patients with NCDs can access and view a patient portal, their satisfaction with care improves, allowing for better management of their conditions as well as increasing their empowerment and engagement in their own medical decisions (15-17).
To maximise the impact of care on NCDs patients, the EHR should promote a more patient-centric healthcare system, involve them in decision-making processes about their care and encourage them to modify unhealthy behaviours by monitoring indicators, introducing vital data and setting health goals. This allows patients to effectively participate in their own healthcare and increases the effectiveness of communication among physicians.
This research indicates that physicians saw a need for more effective programs to promote healthy nutrition and physical activity as well as better access to nutritionists. There is a great opportunity for multisectoral collaboration between nutritionists and dietitians in the private sector and MOH facilities. One option, which could be facilitated through the EHR, would be a nutrition referral scheme to facilitate formal referral of MOH PHC patients to an accredited dietitian. The interviewees acknowledged providing nutrition counselling forms part of their role as healthcare providers (18); however, they are not always able to provide detailed nutrition advice that results in meaningful changes for their patients (19); thus, collaboration between medical professionals and nutritionists is essential (20). Studies have reported on the effectiveness and cost benefits of dietitians’ intervention in NCDs patients, including lowering risk factors associated with NCDs, blood pressure, glucose levels, lipid levels and weight; this is particularly effective when the dietitians are part of a multidisciplinary healthcare team (21-24).
The key enablers of increased physical activity among patients with NCDs in PHCs are social support, multi-disciplinary approaches and motivational interviewing (25). Cost-effective interventions such as counselling based on self-reported activities can positively impact the health outcomes of NCDs patients, increasing levels of physical activity and reducing the risk of NCDs. Frank (26) found that physical activity interventions and counselling had a positive effect in the short- to medium-term on patients with NCDs. As these patients tend to regularly attend primary healthcare centres, screening programs for physical activity during consultations should be adopted. The EHR could help patients make positive health behaviour changes by tracking the delivery of preventive care that recommended across primary healthcare centres (27, 28) and montioring patient responses. This study stresses the need for interventions that encourage promoting the frequency of physical activity, for example, collaborating with gyms to create referral programs.
The MOH placed a lot of emphasis on technology to enhance NCD care. The Wasfaty prescribing program is considered a positive step, providing easier access for most patients to their medications. Improving medication policies and patient adherence reduces the economic and health burdens caused by NCDs (29). However, Wasfaty may be less attractive to elderly patients living within walking distance to their PHCs, as they prefer to have their medications dispensed from the same PHC rather than being referred to a separate pharmacy. Solutions to this include policies that ensure prescribed medications are available at PHCs and home delivery/mail delivery. Overall, reducing barriers to obtaining medications improves adherence to medication (30). Therefore, medication services need to be responsive to the needs of older and disadvantaged people.
The EHR has been implemented in chronic disease clinics at PHCs in order to improve the quality and efficiency of the healthcare they offer. The present study has found that physicians must use three different platforms to complete patient care actions, which increases their workload. A critical further improvement to the EHR functionalities is integrating the three platforms to simplify physician requirements in delivering clinical care. This is an important barrier to obtaining the full benefits of the EHR system, as reducing administrative task time and complexity can increase physicians’ clinical time, potentially quality of care and work satisfaction (31, 32).
Integration of patient records
The MOH should prioritise completing linkages between the MOH and other private and governmental health agencies EHR systems. Disconnected EHR systems between sectors obviously have implications for efficiency of healthcare delivery. A singular system, or at least systems that can inter-communicate, should be implemented in all hospitals, clinics and specialised centres in the country to ensure one unified electronic patient record that is easily accessible regardless of where the patient is being treated. Integrating patient records could significantly reduce unnecessary duplication of services and care and positively impact the country’s healthcare budget, for example by preventing the unnecessary repetition of pathology and radiology tests (33). It can reduce medication wastage and improves coordination and thereby quality of patient care by facilitating physicians access patient information where patients use different healthcare clinics. A structured exchange of clinical information among healthcare providers of NCDs patients enhances care coordination and improves that continuity and safety of care; it also supports better NCDs management (34, 35).