University of Puthisastra (UP), Phnom Penh Cambodia

Cambodia has made remarkable strides in improving its healthcare system over the past decade, but the system still faces significant challenges (World Health Organization, 2020). Cambodia's healthcare system was severely disrupted and dismantled during the Khmer Rouge regime (1975-1979), which resulted in the deaths of an estimated 1.7 million Cambodians. Cambodia continues to face significant challenges in providing universal access to quality healthcare, particularly in rural areas and among marginalized populations. Efforts are underway to address longstanding challenges such as inadequate funding, limited human resources, and weak health information systems. In recent years, the government and international aid agencies such as the United Nations Development Programme have renewed their focus on strengthening Cambodia's healthcare system, with an emphasis on the adoption of electronic health records (EHRs) and other digital health technologies. 

One of the key challenges to weak health information systems is the lack of trained healthcare professionals, specifically nurses, who are skilled in the use of EHRs. The adoption of EHRs in Cambodia has been slow and limited. Nurses' acceptance of EHRs is very important. It can be the reason for the success or failure of EHRs implementation (Yontz et al., 2015). Nurses make up the majority of end users. A study by Lorenzi (2004) found that 50% of EHR implementations fail because nurses do not accept it and are not willing to use it. Furthermore, lessons from the COVID-19 pandemic have taught us that now more than ever, nurses need to be involved in technological design. The global and urgent response to the COVID-19 pandemic has forced systems to broadly adopt technologies that allow care and services to shift virtually (Dykes et al.,2021). 

The negative effects of not having a functioning electronic health system can be particularly pronounced in lower and lower-middle-income countries like Cambodia and include:

• Limited access to patient information: patient records may be stored in paper-based systems, making it difficult for healthcare providers to access and share patient information.

• Increased administrative burden: Paper-based systems require significant administrative effort, which can be costly in resource-constrained settings.

• Reduced efficiency: Electronic health systems can streamline healthcare processes, improve communication between healthcare providers, and automate administrative tasks. 

• Limited ability to track public health trends:  public health officials may have limited resources to monitor disease outbreaks and identify emerging health concerns. 

• Incomplete or inaccurate data: Paper-based systems are prone to errors and missing information, leading to incomplete or inaccurate patient data. Inaccurate data can have particularly severe consequences.

In 2016, the Ministry of Health launched a five-year e-Health Strategic Plan, which aims to establish a national e-Health system and promote the use of EHRs in healthcare facilities throughout the country. The plan included the development of standards for EHR systems, the establishment of an electronic medical records (EMR) system in selected healthcare facilities, and the training of healthcare professionals. In 2022, Twenty hospitals and clinics in 3 cities participated in the “Leveraging Technology to Upgrade Cambodian Healthcare” project to “go digital and go green” by switching from traditional paper-based operations to a new digital hospital management system.

The goal of our nursing faculty team is to expedite the implementation and usage of eHRs by nurses across the country by providing pre-service, technology-based education to nursing students as a part of the University of Puthisastra curriculum. it is essential that new nurses are trained in EHRs to ensure that they are prepared to use them in their practice. EHRs have the potential to improve efficiency, accuracy, resiliency, interoperability, disease surveillance, data-driven decision-making, and the quality of healthcare delivery. The focus of the software training will take place on campus in the computer labs in the library. It will be implemented in the course that is currently being lectured annually at the University of Puthisastra (UP), titled “Nursing Informatics” by a nurse faculty member in the Associate Nursing Degree, Bachelor Science Nursing Degree, and ADN to BSN Bridging Programs.

The example demo can be found on this link: https://ehrgo.com/

The example video demo can be found on this link: Take a Tour of EHR Go

EHR Go is an educational Electronic Health Record (EHR) and learning platform, designed to encourage students to see the holistic nature of healthcare while becoming proficient in its technology. EHR Go includes 700+ customizable patient cases and activities built around the diverse and realistic human stories healthcare professionals see every day. Used in all healthcare disciplines, Go is fully interprofessional in simulation, classroom, lab, practice, or for clinicals. EHR software training helps nursing students learn to document patient care, including their medical history, diagnoses, medications, and treatment plans.

For nursing students, EHR software can provide a number of benefits, including:

• Real-world experience: Using EHR educational software during nursing school can give students hands-on experience with a system that they will likely use in their future careers.

• Enhanced efficiency: EHR software can streamline many aspects of patient care, allowing nursing students to work more efficiently and analyze data recorded in simulated patient cases

• Improved patient safety: EHR software can reduce the risk of errors and improve patient safety by providing access to important simulated patient information.

• Better collaboration: teaches students how to collaborate with healthcare providers, making it easier to share patient information and work together to develop treatment plans.

EHR Go allows faculty to create and author their own content that is applicable to a Cambodian cultural context. EHR Go is being utilized in other Asian educational settings including the Philippines, Malaysia, and Hong Kong.  All UP students are required to complete basic English language courses to attend and can therefore accommodate a non-Khmer software program. In addition, the healthcare system in Cambodia uses English as its primary language for several reasons, despite Khmer being the official language of the country. English has become the global language of medicine and healthcare, and many medical texts and journals are written in English. As a result, many healthcare professionals in Cambodia are trained in English and use it as a common language to communicate with colleagues and patients who speak different languages.

According to a 2020 report by the World Health Organization (WHO), Cambodia has made progress in improving healthcare access and outcomes, but significant gaps still exist, particularly for low-income and marginalized populations. The report notes that more than half of the population lives in rural areas, where access to healthcare is often limited, and poverty rates are higher. Additionally, certain groups face even greater challenges, such as ethnic minorities, people with disabilities, and those living in remote areas. The WHO report notes that these groups often have limited access to health services due to a lack of transportation, financial constraints, and social and cultural barriers. Currently, Cambodia has only 1.4 doctors and 9.5 nurses and midwives per 10,000 people. This is significantly below the average of 9 doctors and 19 nurses per 10,000 people among low- and lower-middle-income countries in the East Asia and Pacific region. 

Electronic Health Records (EHRs) can play a vital role in supporting telehealth services for underserved populations. According to the World Bank, as of 2020, the percentage of Cambodians using telecommunications was 129.8%, indicating that there are more mobile phone subscriptions than there are people in Cambodia. Nurses play a critical role in the delivery of telehealth services in developing countries. Through their expertise and knowledge, nurses can help to improve the quality of care, reduce healthcare costs, and enhance patient outcomes in remote and underserved areas. Here are some ways in which healthcare providers and nurses use EHRs in telehealth:

• Improved and remote access to patient information and data: EHRs can provide healthcare providers with quick and easy access to patient information.

• Improved patient health record resiliency: EHRs are protected against natural disasters, and the need for storage of paper records and quality infrastructures is eliminated along with the need for human resources to maintain and update records.

• Improved public health: EHRs can provide valuable data on public health trends and disease outbreaks, helping public health officials to identify and respond to emerging health threats more quickly.

• Enhanced patient safety: EHRs can help reduce medical errors, by providing accurate and up-to-date patient information. This can be particularly important in developing countries where medication and medical errors are more common.

• Providing triage and initial assessment: Nurses can use telehealth technologies to triage patients and provide initial assessments, including vital signs monitoring, symptom and medication management, reducing the burden on healthcare systems.

• Improved Communication: EHRs can facilitate communication between healthcare providers, patients, and caregivers in different locations. With EHRs, healthcare providers can share patient data, collaborate on treatment plans, and provide follow-up care without being in the same physical location.

• Improved patient monitoring: EHRs can also help to improve patient monitoring during telehealth consultations. 

• More efficient use of resources: EHRs can help to make telehealth services more efficient and cost-effective by reducing administrative tasks and eliminating duplicate tests and procedures. This can help to make telehealth services more accessible to patients in Cambodia who may not have access to traditional healthcare services.

The faculty at UP are committed to engaging with the local community and addressing healthcare challenges in Cambodia. Through clinical practice, community outreach, research, and service learning, faculty members are able to stay connected to the needs and priorities of the local population and contribute to improving healthcare access and outcomes. Here are just a few examples:

• Clinical practice: Many faculty members at UP are also practicing clinicians, providing medical and dental care in hospitals, clinics, and other healthcare facilities throughout Cambodia. This direct interaction with patients and the community helps faculty members stay connected to the needs and challenges of the local population.

• Community outreach: UP faculty members are involved in a variety of community outreach activities, including health screenings, health education programs, and partnerships with local organizations to improve healthcare access and outcomes.

• Research: Many faculty members at UP conduct research on topics related to health and healthcare in Cambodia, working closely with local communities to identify research questions and gather data. This research can help inform policies and programs that improve health outcomes for the local population.

• Service learning: UP offers service learning opportunities for students, providing hands-on experience working with local communities and organizations to address healthcare challenges. Faculty members are often involved in designing and leading these service-learning programs, helping to connect students with the local community, and providing mentorship and guidance.

The University of Puthistra faculty has already launched a new Nursing Informatics course this past year, a cutting-edge course globally. Nursing informatics courses are becoming increasingly important in nursing schools as healthcare facilities adopt electronic health records (EHRs) and other health information technologies. These courses teach nursing students how to use technology to manage patient data, enhance communication, and improve patient outcomes.

There are several ways that the University of Puthisastra (UP) can promote electronic health records (EHR) education among its students. The UP has nursing faculty staff who have the advanced education and experience to: 

• Provide access to EHR educational software: UP can provide students with access to EHR software so they can practice using it in a safe and controlled environment in the computer lab on campus. This can help students become more comfortable with EHRs and better prepared for using them in the workplace.

• UP has the facilities to host EHR-related events and workshops: UP can host events and workshops that focus on EHRs and related topics, such as data security and privacy. This can help raise awareness among students and encourage them to pursue careers in healthcare IT and nursing informatics.

The University of Puthisastra currently has a Bachelor of Science in Nursing (4-year program), an Associate Degree in Nursing (3-year program), and the BSN Bridging Program (2-year program). All programs require students to complete a Nursing Informatics Course, newly implemented into academic requirements guided by the Cambodia Council of Nursing.  The total number of nursing students annually that this pilot EHRs educational platform will impact presently at UP is 80 nursing students. An EHR educational platform also has the ability to impact other departments within the university. This includes annually the medical (70-100 students), pharmacy 70-100 students), and laboratory (10-20 students) departments.  Furthermore, with the assistance of software developers to create a custom Cambodian EHR system leveraging existing open-source EHR platforms for free, other health science universities could potentially benefit from this learning platform.

As of 2018, Cambodia has an estimated population of over 16 million people, and the country had a total of 1,252 public health facilities, including 79 hospitals, 870 health centers, and 303 health posts. This translates to around 5.5 million people in Cambodia.  As of 2021, it is estimated that about 35% of Cambodia's population lives below the national poverty line, which is defined as an income of less than $1.90 per day and is considered poor or vulnerable.  

Moreover, while the government provides free healthcare services at public health facilities, many people in Cambodia still face financial barriers to accessing healthcare, including the cost of transportation to medical facilities, out-of-pocket expenses, and informal payments to healthcare providers. While Cambodia's healthcare system serves millions of people, access to healthcare remains a challenge for many, particularly those living in rural areas or facing financial barriers. 

Cambodia faces several challenges to providing quality pre-service education, including weak governance and regulation, a mismatch between the competency of graduates and the population’s health needs, outdated curricula, poor quality of instruction, ineffective use of practice sites, inadequate facilities and equipment, and poor assessment of students and programs. Improving the quality of the system for educating health professionals will be pivotal for enhancing Cambodia's growing healthcare system  (World Bank, 2021). 

We are applying to SOLVE because we need mentoring and financial assistance. Our goal is to expand our current pilot program to all the nursing programs and expand to other departments with the EHR Go software. We need financial assistance for the purchase of subscriptions, for an additional nursing faculty member who can focus on the piloting and implementation, and for sustainability to explore the feasibility of designing an educational electronic health records system and a learning platform within the Cambodian context. We realize this can be a complex undertaking that requires significant technical expertise and resources. In order to avoid copyright infringement from EHR Go or any other commercial EHR vendor, the university would need help to develop its own proprietary system or use an open-source EHR platform that is not subject to copyright restrictions.

We need help with developing a strong monitoring evaluation process along with a plan for rolling out this entire process. Presently, the first pilot course implementing the EHR Go software is set to launch within the next few months. Multiple activities within the EHR Go platforms have already been created for the Cambodian context targeting nursing vital signs data entry and documentation along with evidence-based practice. For sustainability purposes, additional educational EHRs software development implementing a simulation of the Cambodian healthcare system is crucial. This takes additional resources from an IT software development company. Consideration for the development of EHR educational learning software based on the Cambodia Healthcare System would be a long-term goal that includes diseases and illnesses related to Southeast Asia. In addition to creating simulated patients that address Cambodian social determinants of health. Legal and business management support would be needed for additional software development. Financial support would be necessary for interactive faculty training, peer learning support, ongoing software support, and regular faculty and student feedback is essential.

Monitoring and evaluation (M&E) is critical when implementing software for nurses in developing countries for several reasons:

• Ensuring effectiveness: M&E helps to assess whether the software is effective in improving healthcare delivery and patient outcomes. It provides feedback on what is working well and what needs to be improved to optimize the software's impact.

• Identifying challenges: M&E allows for the identification of challenges that may hinder the software's adoption and use. These challenges could be related to infrastructure, training, or cultural factors. Identifying these challenges early on helps to address them promptly, preventing setbacks in the implementation process.

• Resource allocation: M&E provides information on how resources are being used and whether they are being used efficiently. This helps decision-makers to allocate resources effectively, ensuring that the software is implemented in a sustainable and cost-effective way.

• Accountability: M&E helps to hold stakeholders accountable for their roles and responsibilities in the implementation process. This ensures that everyone involved is working towards achieving the same goals and objectives.

• Continuous improvement: M&E allows for continuous improvement of the software and the implementation process. Regular feedback and monitoring enable developers to refine and improve the software to better meet the needs of nurses and patients

The Cambodia Council of Nurses has just this year published a national curriculum requiring the course Nursing Informatics within academia.  Nursing informatics is considered a cutting-edge course for undergraduate nursing programs globally because it is a relatively new and rapidly evolving field that is at the forefront of healthcare innovation. Nursing informatics combines the fields of nursing, computer science, and information science to improve patient care through the use of technology.

Here are some reasons why nursing informatics is a cutting-edge course for undergraduate nursing programs:

• Technology is transforming healthcare: The use of technology in healthcare is rapidly expanding, and nursing informatics provides students with the knowledge and skills to stay up-to-date with the latest innovations in healthcare technology.

• Increasing demand for healthcare data: With the increasing amount of healthcare data being generated, there is a need for professionals who can manage, analyze, and use this data to improve patient outcomes. Nursing informatics provides students with the skills to manage and use healthcare data effectively.

• Advancements in EHRs and other HIT systems: Electronic health records (EHRs) and other health information technology (HIT) systems are transforming the way healthcare is delivered, and nursing informatics provides students with the skills to work with these systems and ensure they are designed and implemented effectively.

• Improved patient outcomes: Nursing informatics can help improve patient outcomes by providing healthcare professionals with better access to patient data and information, facilitating communication between healthcare providers, and improving the quality of care provided.

• Opportunities for innovation: As a cutting-edge field, nursing informatics offers opportunities for students to innovate and develop new technologies and systems that can improve patient care.

Using simulated electronic health records (EHRs) is a unique aspect of nursing informatics courses because they provide students with hands-on experience in working with patient data in a safe and controlled environment.

EHRs are digital versions of patient medical records that contain information about a patient's health history, medications, test results, and other important information. In real-world healthcare settings, nurses and other healthcare professionals use EHRs to access and document patient information, track patient progress, and communicate with other members of the healthcare team.

By using simulated EHRs in nursing informatics courses, students can learn how to navigate and use these systems without putting actual patients at risk. This allows students to practice using EHRs to collect and document patient information, create care plans, and communicate with other healthcare professionals. Simulated EHRs also provide opportunities for students to learn about health informatics concepts and technologies, such as clinical decision support systems, data analytics, and telehealth.

One-Year Goal:  UP has secured a small grant to pilot the implementation of EHR Go with 80 nursing students in the nursing program.  We will implement the EHR Go activities into the computer lab component of our Nursing Informatics Course in 2023. We will Monitor and Evaluate this pilot.

5-Year Goal: UP will implement an educational EHR software and learning platform in all the Nursing Informatics courses with application to the Cambodian context for the ADN, BSN, and Bridging programs. Ultimately the EHR educational platform will be expanded by piloting the software in the pharmacy, medical, and laboratory departments as well at UP.

• Increase Access to Health Information: One of the impact goals of implementing an educational EHR and learning platform in nursing curricula in a developing country will be to increase access to health information. This can be achieved by training nursing students to collect and analyze data on patient health, track disease outbreaks, and monitor public health trends.

  • EHR Student Activities will include activities completed within the computer lab that will simulate real-world scenarios to collect, analyze, and interpret patient data

  • EHR Student Activities will have access to comprehensive patient information including medical history, laboratory results, and medication lists

  • EHR Student Activities will include accessing information in real-time so they can access up-to-date patient information

  • EHR Student Activities include access to a centralized location for patient data

• Improve Patient Outcomes: Implementing an educational EHR and learning platform in the nursing curriculum should also aim to improve patient outcomes. By training nursing students to use EHRs to collect and analyze patient data, they will be better equipped to provide accurate diagnoses and develop effective treatment plans, which can ultimately improve patient outcomes.

  • EHR Student activities will include developing effective nursing treatment plans that will ultimately improve patient outcomes

• Enhance Health Systems: The use of EHRs can help enhance health systems in developing countries by improving the efficiency of healthcare delivery, reducing medical errors, and increasing patient safety. Implementing an educational EHR and learning platform in the nursing curriculum should aim to train nursing students to use EHRs effectively, which will contribute to a more efficient and effective healthcare system.

  • EHR Student Activities will train nursing students to use EHRs effectively which will contribute to a more efficient and efficient healthcare system

• Increase Interprofessional Collaboration: EHRs provide a platform for interprofessional collaboration, allowing healthcare professionals to work together in a coordinated and efficient manner, which will contribute to a more integrated healthcare system.

  • EHR Student Activities will include collaborating with other healthcare departments including pharmacy, lab, dietetics, and healthcare professionals

• Support Professional Development: Implementing an educational EHR and learning platform in the nursing curriculum will aim to support professional development. By providing nursing students with the necessary knowledge and skills to use EHRs effectively, which will contribute to a more skilled and knowledgeable workforce.

  • EHR Student Activities will equip students to pursue further education and training opportunities in the field of healthcare contributing to a more skilled and knowledgeable workforce.

Implementing an educational Electronic Health Record (EHR) and learning platform in the nursing curriculum can contribute to achieving the United Nations Sustainable Development Goal (SDG) number 4, which is to "Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all." In this section, I will list specific indicators that can be used to measure the implementation of an educational EHR and learning platform, according to the United Nations SDG number 4.

1. Access to educational resources: One indicator of the implementation of an educational EHR and learning platform is access to educational resources. This can be measured by the number of students who have access to the platform, the number of courses available on the platform, and the quality of the educational resources available. This indicator is important because it relates to the goal of providing inclusive and equitable education for all (SDG 4).

2. Student engagement: Another indicator of the implementation of an educational EHR and learning platform is student engagement. This can be measured by the level of student participation in online courses, the completion rate of assignments, and the level of student satisfaction with the platform. This indicator is important because it relates to the goal of promoting lifelong learning opportunities for all (SDG 4).

3. Skills and competencies: A third indicator of the implementation of an educational EHR and learning platform is the development of skills and competencies. This can be measured by the level of proficiency demonstrated by students in using the EHR system, as well as their ability to apply theoretical concepts to real-world nursing scenarios. This indicator is important because it relates to the goal of promoting quality education (SDG 4).

4. Career outcomes: A fourth indicator of the implementation of an educational EHR and learning platform is career outcomes. This can be measured by the employment rate of nursing graduates, their starting salaries, and the level of job satisfaction reported by graduates. This indicator is important because it relates to the goal of promoting sustainable economic growth (SDG 4).

Implementing an educational electronic healthcare record (EHR) into nursing curriculum can ultimately improve patient outcomes in Cambodia through several pathways. The following is a theory of change that outlines these pathways and the underlying assumptions that support them:

Inputs:

• Implementation of educational EHR software in nursing curriculum

• Training nursing students to use EHR software effectively

• Access to comprehensive patient information through EHR software

• Adequate infrastructure and resources to support the use of EHRs in healthcare delivery

Outputs:

• Increased ability of nursing students to collect and analyze patient data

• Improved accuracy of diagnoses and treatment plans

• Enhanced interprofessional collaboration among healthcare professionals

• Improved patient safety through reduced medical errors

• Improved efficiency of healthcare delivery

Outcomes:

• Improved patient outcomes, including increased quality of care, reduced mortality rates, and improved health outcomes

Assumptions:

• Nursing students who are trained to use EHR software effectively will be better equipped to provide accurate diagnoses and develop effective treatment plans. This assumption is supported by research that has shown that using EHRs can improve the accuracy of diagnoses and treatment plans (Kim, Jung, & Hong, 2016; Kharrazi, et al., 2018).

• Adequate infrastructure and resources are available to support the use of EHRs in healthcare delivery in Cambodia. This assumption is supported by the Cambodian government's efforts to improve healthcare infrastructure and promote the use of digital technologies in healthcare (Cambodian Ministry of Health, 2016; Le, et al., 2018).

• Enhanced interprofessional collaboration among healthcare professionals can improve patient outcomes by enabling more coordinated and efficient care. This assumption is supported by research that has shown that interprofessional collaboration can improve patient outcomes (Makaryus, Friedman, & Ravi, 2014; Nielsen, et al., 2019).

• Improved patient safety through reduced medical errors can ultimately improve patient outcomes by reducing the risk of harm to patients. This assumption is supported by research that has shown that using EHRs can reduce the incidence of medical errors (Linder, et al., 2014; Panesar, et al., 2015).

• Improved efficiency of healthcare delivery can ultimately improve patient outcomes by reducing wait times and increasing access to care. This assumption is supported by research that has shown that using EHRs can improve the efficiency of healthcare delivery (Deng, et al., 2016; Hsiao, Hing, & Socey, 2017).

In conclusion, implementing an educational EHR into nursing curriculum can ultimately improve patient outcomes in Cambodia through improved accuracy of diagnoses and treatment plans, enhanced interprofessional collaboration, improved patient safety through reduced medical errors, and improved efficiency of healthcare delivery. These assumptions are supported by research that has shown the benefits and challenges of using EHRs in healthcare delivery in developing countries, including Cambodia.

References:

• Cambodian Ministry of Health. (2016). Digital health in Cambodia: Strategic directions for development. Retrieved from https://www.moh.gov.kh/wp-cont...

• Deng, Z., Hong, Z., Ren, C., Zhang, W., & Xiang, F. (2016). Impact of electronic health records on the efficiency and safety of care: A systematic review and meta-analysis. Journal of the American Medical Informatics Association, 23(6), 119-129.

• Hsiao, C.-J., Hing, E., & Socey, T. C. (2017). Categorizing health information

EHR Go is a web-based software platform that is designed to provide nursing students with a simulated environment for learning how to use electronic health records (EHRs) in clinical practice. The software is designed to be used as a tool for nursing students to develop the necessary skills and competencies to work with EHRs in clinical settings. This section will describe how EHR Go works and how it can help nursing students understand how to use electronic health records, with citations and references.

EHR Go is a software platform that provides nursing students with access to simulated electronic health records (EHRs). The software is designed to be used in nursing education programs to provide students with a safe and controlled environment for learning how to use EHRs. The simulated EHRs in EHR Go are designed to mimic the types of EHRs that nurses would encounter in clinical practice.

EHR Go is designed to be user-friendly, with an interface that is easy to navigate. The software provides nursing students with access to patient charts, where they can view patient demographics, medical histories, and other important patient information. The software also allows students to input and update patient data, such as vital signs and medication orders, and to view the results of laboratory tests and diagnostic imaging studies.

One of the key features of EHR Go is that it provides nursing students with immediate feedback on their interactions with the simulated EHRs. The software is designed to provide feedback in real-time, allowing students to correct any errors or mistakes that they make as they work with the EHRs. This feature is designed to help nursing students develop the necessary skills and competencies to work with EHRs in clinical practice.

Research has shown that using simulated EHRs, such as those provided by EHR Go, can help nursing students to develop the necessary skills and competencies to work with EHRs in clinical practice (LeFlore et al., 2017; Wilson et al., 2017). Using simulated EHRs can also help to improve nursing students' confidence in their ability to use EHRs (Wilson et al., 2017).

In conclusion, EHR Go is a web-based software platform that provides nursing students with a simulated environment for learning how to use electronic health records. The software is designed to be user-friendly and provides nursing students with immediate feedback on their interactions with the simulated EHRs. Research has shown that using simulated EHRs, such as those provided by EHR Go, can help nursing students to develop the necessary skills and competencies to work with EHRs in clinical practice, and can improve their confidence in their ability to use EHRs.

References:

LeFlore, J. L., Anderson, M., Zielke, M. A., Nelson, K. A., Thomas, P. E., Hardee, G., ... & Blouch, D. L. (2017). Simulation in the classroom: A new avenue for nursing education. Journal of Nursing Education and Practice, 7(8), 12-21.

Wilson, R. D., Fitton, L., Paterson, B., & Fitzsimmons, A. (2017). Evaluation of a simulated electronic health record for teaching electronic health record skills in undergraduate nursing education. Nurse Education in Practice, 23, 19-24.

Our nursing faculty is committed to promoting diversity, equity, and inclusion, and we are proud to have a dedicated DEI team consisting of three nurses - one Cambodian female, one Cambodian male, and one American female. This team brings a wealth of knowledge and experience to our efforts to create a more inclusive and equitable learning environment for our students. The team leads are Cambodian nationals which is beneficial for the purpose of understanding cultural context, sustainability, capacity development, and cost-effectiveness

Incorporating diversity, equity, and inclusivity (DEI) into an educational electronic health record (EHR) software in UP’s nursing curriculum in Cambodia inclusive of ethnic groups is a critical step in ensuring that nursing students are well-prepared to work with patients from diverse backgrounds. Here are some steps that being taken to implement DEI in an educational EHR software into UP’s nursing curriculum in Cambodia:

• Assess the cultural context: Assessing the cultural context of Cambodia and the ethnic groups that are present. This will help identify areas of the curriculum where DEI can be incorporated.There are several ethnic groups in Cambodia that are considered marginalized and face social, economic, and political challenges. These groups include: Chams, Vietnamese, Chinese, Stieng, and other ethnic minorities.

• Identify relevant topics: Identify relevant topics related to DEI, such as cultural competency, health disparities, and social determinants of health, that are particularly relevant to the cultural context of Cambodia.

• Incorporate local knowledge: By having nationals who are team leads, this assits in Incorporating local knowledge and cultural practices into the curriculum to ensure that students have an understanding of the cultural context of the communities they will be working with.

• Develop learning objectives: Develop specific learning objectives that incorporate DEI into the EHR software education, such as understanding how to document patient care in a way that is sensitive to cultural differences.

• Create content: Develop content for the EHR software that addresses DEI topics relevant to the cultural context of the developing country. Use case studies and scenarios that highlight the importance of DEI in nursing practice in the local context.

• Incorporate DEI into assessments: Incorporate DEI into assessments of student learning, such as in the simulated case scenarios in the EHR. This will ensure that students are held accountable for understanding and incorporating DEI into their nursing practice.

• Continuously evaluate and update the curriculum: Continuously evaluate the effectiveness of the DEI curriculum in the EHR software education and update it as needed to reflect changes in healthcare and patient needs.

Executive Summary:

This business plan proposes the implementation of an educational electronic health record (EHR) software platform, EHR Go, into the nursing curriculum at the University of Puthisastra in Cambodia. The platform will provide nursing students with hands-on experience using EHR software, preparing them for the digital healthcare environment of the future. The project will benefit the university, nursing students, and the healthcare system in Cambodia, promoting improved healthcare delivery and ultimately contributing to improved health outcomes. Revenue will be generated through subscription fees paid by the university.

Business Description:

EHR Go is an educational EHR software platform that provides nursing students with hands-on experience using EHR software. The platform offers a simulated EHR system that mimics a real-life clinical setting. Students can practice charting patient data, communicating with other healthcare professionals, and using EHR software to support patient care. The platform is designed to be user-friendly and easy to navigate, allowing students to quickly become proficient in using EHR software.

Value Proposition:

The implementation of EHR Go into the nursing curriculum at the University of Puthisastra in Cambodia will provide several benefits to nursing students, the university, and the healthcare system in Cambodia. Nursing students will gain practical experience using EHR software, preparing them for the digital healthcare environment of the future. The university will enhance the quality of its nursing curriculum and gain a competitive edge over other universities that do not offer hands-on EHR training. The healthcare system in Cambodia will benefit from improved healthcare delivery, as nursing students become more proficient in using EHR software and can support the efficient and effective delivery of healthcare services.

Revenue Model:

The revenue model for EHR Go in Cambodia will be based on subscription fees paid by the university. The subscription fee will be determined based on the number of students using the platform, and will be renewed annually. The fee will include access to the platform and support from the EHR Go team.

Marketing Strategy:

The marketing strategy for EHR Go in Cambodia will focus on promoting the benefits of hands-on EHR training for nursing students and the healthcare system. The EHR Go team will work closely with the university to promote the platform and provide support for implementation. Social media, email marketing, and events will be used to promote the platform to nursing students and faculty.

Conclusion:

The implementation of EHR Go into the nursing curriculum of a university in Cambodia will provide nursing students with practical experience using EHR software, preparing them for the digital healthcare environment of the future. The project will benefit the university, nursing students, and the healthcare system in Cambodia, promoting improved healthcare delivery and ultimately contributing to improved health outcomes. Revenue will be generated through subscription fees paid by the university.

h subscription fees paid by the university.

Sustainability

Creating sustainability for a university in a developing country when using an educational electronic health records platform through subscriptions can be challenging but there are a few strategies that UP is considering  to ensure long-term sustainability:

• Establish partnerships with healthcare providers: Universities can establish partnerships with healthcare providers in the local community to promote the use of the educational EHR platform. Healthcare providers can be encouraged to subscribe to the platform and can also provide feedback on its usefulness in practice. These partnerships can create a network of support for the platform and increase its visibility and adoption.

• Implement a fee-for-service model: In addition to subscription fees, universities can consider implementing a fee-for-service model where healthcare providers pay a fee for each use of the platform. This model can provide a more sustainable revenue stream and can also be used to cover maintenance and upgrade costs.

• Offer training and support: Universities can offer training and support to healthcare providers to increase the adoption and effectiveness of the platform. By providing training and support, universities can increase the value of the platform and ensure that it is being used to its full potential.

• Promote research and evaluation: Universities can conduct research and evaluation on the effectiveness of the platform in improving healthcare delivery and patient outcomes. This can help to generate evidence-based data that can be used to promote the platform to healthcare providers and policy-makers, increasing its sustainability.

• Seek funding from external sources: Universities can seek funding from external sources, such as government agencies, non-profit organizations, or philanthropic foundations, to support the implementation and sustainability of the platform. These external sources can provide additional financial support and can also help to increase the visibility and adoption of the platform.

• Creating an electronic health records system and a learning platform can be a complex undertaking that requires significant technical expertise and resources. In order to avoid copyright infringement from EHR Go or any other commercial EHR vendor, the university would need to develop their own proprietary system or use an open-source EHR platform that is not subject to copyright restrictions.

  • One option would be to collaborate with local software developers to create a custom EHR system that meets the university's specific needs. This would require significant resources and expertise in software development, database management, and user experience design.

  • Another option would be to leverage existing open-source EHR platforms that are available for free and can be customized to meet the university's needs. Open-source platforms like OpenMRS, GNU Health, and OpenEMR are widely used in developing countries and can be modified to include educational components.

  • Regardless of the approach taken, it is important for the university to consult with legal experts to ensure that they are not infringing on any existing copyright or intellectual property rights. Additionally, they should seek input from stakeholders in the healthcare and education sectors to ensure that the EHR system and learning platform meet the needs of the community they serve.

We are pleased to announce that the University of Puthisastra has been awarded a $4000 education grant from a local national registered NGO. The grant will be used to pilot an educational electronic health record and learning platform for 80 nursing students at the university through subscriptions. The aim of this initiative is to provide students with practical experience in managing electronic health records and to enhance their learning outcomes in the field of healthcare. We are grateful for their generous support in this important endeavor.

Here are the steps that UP has been taking and plans to take. Currently UP is preparing for pilot implemenation of an electronic health record educational platform:

• Planning: The first step is to identify the goals and objectives of the educational platform, determine the target audience of nursing students, and establish a timeline for the project - May/July 2023 ADN Nursing Informatics and Bridging Nursing Informatics courses.

• Platform selection: Next, select EHR Go as a suitable electronic health record educational platform that meets UP's needs and aligns with our goals.

• Design and development: The next step was to design and develop the content and curriculum for the educational platform. This involves creating courses, assessments, and other learning materials. This has been done and completed following EHR Go 6-month free access to all nursing faculty.

• Testing: Once the platform is developed, test it to identify any bugs or glitches that need to be fixed before launch. This has been done using nurse faculty to practice the activities on computers.

• Pilot implementation: Launch the educational platform in a small group of nurses and monitor their usage and feedback. This pilot implementation helps identify any issues that need to be addressed before rolling out the platform to a larger audience. Set to lauch in May/July 2023.

• Evaluation and improvement: After the pilot implementation, evaluate the platform's effectiveness and make necessary improvements before rolling it out to a larger audience. This will take place at the completion of the course following the 12 week course.