Original Research
The role of process analysis and expert consultation in implementing an electronic medical record solution for multidrug-resistant tuberculosis
Submitted: 06 April 2014 | Published: 18 November 2014
About the author(s)
Rubeshan Perumal, Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, South AfricaHarsha Desai, Department of Health Informatics, School of Nursing and Public Health, University of KwaZulu-Natal, South Africa
Abstract
Methods: The study employs a two phase design. Phase one involves a process analysis of the South African National Tuberculosis Programme and an electronic medical records (EMR) solution and the generation of a detailed process model grounded in the fit between individual task and technology (FITT) theoretical framework using ‘business process modelling notation’. Phase two involves a two round Delphi study in the clinical management of tuberculosis and implementers of EMR solutions. Expert opinion is analysed according to emergent thematic content. Analyses and graphical model representation are performed using Microsoft Excel® and Visio® software.
Results: A detailed process model is constructed which reveals 54 break points, 12 gaps, 3 risks, 5 wastes. Five participants are included in the Delphi study which support the findings of the process analysis. Thematic analysis identifies five themes: the individual, the process, technology, capacity, and collaboration. The opportunity to include synergistic relations across programmes emerges as a strong theme.
Conclusions: Overall, the findings highlight inefficiencies, risk and gaps in the current process and the need for an operational excellence intervention. The study demonstrated the value of process engineering with iterative expert consultation toward developing a meaningful EMR solution consultation in a resource constrained, developing world context.
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