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Table 3 EMR adoption, data quality, implementation trends and incentives: the example of Brazil

From: Feasibility of extracting data from electronic medical records for research: an international comparative study

Typical treatment settings for type 2 diabetes patients • All basic care outside hospitals.
• Public system is represented by public clinics (general physicians and specialists). Limited access to medication, usually low cost drugs given, dispensing often not recorded.
• Private system (25 % of Brazilian population) consists of specialist physicians’ offices clinics. This is where most drug consumption takes place.
EMR adoption rate in the typical treatment setting • Highly varied responses: general physicians 5–40 %, Specialists 5–50 %, Hospitals 7–80 %, Emergency units 50 %. Difficult to capture as it depends on each physician and office.
• Low overall adoption.
• Primary reason for reluctance to EMR and persistent paper culture: concerns among healthcare institutions regarding the security of patient data/concept of physicians owning their patient data and not wanting to forward this to other physicians.
Typical fields covered in the EMR system • Depends on the type and structure of the system used by physician. This would be a clinic by clinic exercise.
• No electronic prescriptions.
• Both public and private hospitals (providing public services) have central database for claims data: only high-cost procedures and high-cost drugs dispensed.
• More data captured in public system as attended by different physicians each time (EMR more favourable).
Average fill rate Difficult to capture. This would be a clinic by clinic exercise.
Fields with close-ended questions As physicians are protective of patient data, open fields may be more common than closed-ended. Some niche specialised systems exist with parameters used by the type of specialist, perhaps more likely to have close-ended questions.
Overall trend on EMR implementation • Trend is growing and expanding slowly.
• All initiatives are confined to private market.
• No large changes in regulations or government mandatory imposed policy that will make change happen faster.
• However, much interest from EMR vendors and accelerating activity expected in the next few years expected as Brazil is the third largest world market for EMR: with >200 million inhabitants, >7000 hospitals, >300,000 physicians, and a mixed public and private healthcare system.
• The EMR market earned revenues of US $145 million in 2012 and estimates to reach US $336 million in 2018 at a compound annual growth rate of 15 percent.
Incentives for EMR implementation • Most important incentive is the necessity to improve services and coordination of care as public and private health sectors are stretched. Likely to follow other countries in EMR implementation.
• Incentives are sectorial, with independent motivations and initiatives.
• Local healthcare information technology (HC IT) market stage drives providers to offer EMR as a module pack within a hospital information system (HIS) solution.
• Very little national or regional incentives. In some states and some cities only.