Highlights of Some Contemporary Challenges

Bongs lainjo


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Title: The Evolution and Dynamics of Electronic Health Record Systems (EHRSs)




The aim of this study is to review the transformation process involved in converting the current manual medical records (MMR) into electronic health record systems (EHRSs). The study also illustrates a life case study conducted by the author as stage one of implementation of the center for Medicare and Medicaid services (CMMS) electronic health record (EHR) incentive program (Cohen et al., 2015). The third objective is to thematically highlight the prevalence, achievements, challenges and prognosis of implementing EHRSs.


The study is focused on global, regional and national geopolitical systems. A group of select industrial countries in North America, Oceanic, East Asia, and Scandinavia is used to illustrate the dynamics and transformation system of medical records from manual to electronic. India is also included.


The methodology that is used analyzes the global, regional and the national implementation rates of the electronic health records systems. The review is made based on the different governments’ role in making sure that the system is a success without compromising the quality of service. Also physicians’ attitudes towards the system were used as part of the review process. A comprehensive analysis of the whole EHRSs ecosystems is performed.


The findings in the study were that the implemented EHRSs are faced with a lot of challenges even if there are some subsequent benefits (Delbanco, 2008; Phillips et al., 2009). The systems are prone to transcribing errors that the user may not understand and address (Phillips et al., 2009). The errors maybe transferred to the patient’s medical results: a process that is likely to compromises the patient’s safety and quality of service. There is also the likelihood that people using the system may not fully embrace it (Davis & Stoots, 2013). According to study findings, while significant efforts have been made by various governments to encourage EHRSs, enormous challenges (standardization, programming glitches, system failures, vulnerability of patient records, confidentiality, other internal and external factors) continue to slow down the process. There is a global absence of instituting an effective and inclusive team to contribute in the design and development of EHRSs. Inadequate oversight has also impacted implementation processes. Denmark remains a trailblazer in efforts to computerize manual medical records.


Innovations come with relative risks. The MMRs are no exception and in this case, the challenges are even more exacerbated by the involvement of different players at the various stages of the transformation process. Potential setbacks range from human errors, to computer system breakdown to uncontrolled external factors and sometimes, internal factors. While caution remains a key mantra, stakeholders (government, doctors, patients, service provider etc.) need to balance the benefits of implementation against risks of failure and the degree of vulnerability. And in general, when such initiatives succeed the rest is history.

According to the research findings, various countries have implementation rates based on the degree of government support and involvement (Davis & Stoots, 2013). For example, in the year two thousand and nine, the U.S had the lowest conversion rates as compared to other industrialized countries. This was due to the lack of government participation including incentives encouraging institutions to participate in converting their respective manual systems into electronic ones. This outlook changed in 2012 when the U.S government became more actively involved: an initiative that has seen an improvement in the conversion rate (Balgorsky, 2014).


In general and as expected, the implementation of an EHRS has made various achievements such as reducing the bulkiness that comes with paper work, the patient’s records cannot be easily misplaced and patient record access has improved significantly. The preceding remarks notwithstanding the likelihood of compromising patient records, though lower remains a major concern (Phillips et al., 2009). A compelling complementary and invaluable safeguard is the introduction of strict quality control guidelines. For example, cases where wrong medications are issued to patients and that have fatal effects. An effective and continuously monitoring framework will go a long way in mitigating patient vulnerability. And in general, given the current evolving dynamics, the benefits significantly outweigh the risks especially in circumstances where all the bugs in the systems have been corrected. While a successful implementation is plausible, stakeholders need to be reminded that provision for operating parallel system (manual and electronic simultaneous) for substantial amount of time remains unavoidable. Adapting such a process will guarantee continuity and sustainability.


(Key Words: EHRSs, Prevalence, Achievements, Prognosis, Challenges, Dynamics, CMMS, Global, Regional, National, and Quality of Service)





Below is an audio link of an M and E plan lecture module I recently gave graduate students at the U. of W. Indies Kingston, Jamaica. And for the technically savvy, I have included the outline:

1. Strategic Framework (Logframe, Results Framework) and its importance;

2. Description of a Monitoring and Evaluation Plan;

3. What an M and E plan is used for;

4. Why M and E plans are required;

5. M and E Plan target;

6. M and E Plan stakeholders and 

7. An outline of how to develop and M and E Plan.


Hope you find it useful and do not hesitate to share your thoughts with me.




How often do you visit a sauna? And do you believe in its benefits?

Several years ago during my stint in Asia and based in Kathmandu – Nepal, I had my first experience in a sauna. Before the first visit, I had previously heard about saunas and how useful they are. Of course here in North America, saunas are not as ubiquitous as they are in Finland. In fact in that part of the world, almost every household has one! This of course makes it difficult for anyone to conduct a randomized control trial. They are just no controls!; even though the participants in one study (more later) were divided into three groups of sauna frequency and duration. On the other hand, here, saunas remain a luxury and can only be generally found in a few places where the utilization rates are relatively low. In Asia for example, saunas are in many cases owned and managed by hotel chains and hence availability becomes quite exclusive and limited.

One major difference that I discovered between saunas in Asia and the ones here is the set up and control processes. Here, where they exist, users all seat in and share one heated room (dry and wet environments). In Asia on the other hand, there is a small cabin assigned to every client.

Over the last several years, I have been a yellow dog believer in saunas. And this believe is so compelling that each time I am unable to go to the sauna, I feel quite vulnerable. And as it turned out, there are quite a few regulars too in the CVE. Some of them also visit this hot room as often as I do. One thing I observed mixing with these groups is that the room serves as both forum for camaraderie and “bad blood”. One of my sauna buddies once remarked that some people come to saunas here to flaunt their previous authority: a carry-over from their CEO days. In summary, I have found the level of openness and warmth from many visitors quite positive.

And the benefits? I’m not quite sure what others think. From my experience, each time I visit a sauna and have a good sweat, I feel calm, relaxed, more energetic and stress-free. This includes long and uninterrupted sleeping periods.

In a study published online by JAMA Internal Medicine conducted in Finland among males (no gender overtones implied), the researchers came up with very interesting findings. Before we look at details of this study there are some caveats that need to be highlighted : participants were all males; it was an observational study (no cause and effect outcomes expected); they were dry saunas; duration of stay ranged from 104 to 212 (average was 174) degrees Fahrenheit or 40 to 100 degrees celsius; duration ranged from two to 90 minutes; those who benefited most were people who spent twenty or more minutes bathing.

Setting and Findings: Between 1984 and 1989, researchers recruited and followed a cohort (open) of 2315 middle-aged (42 to 60 years) men in eastern Finland. The participants were asked to fill weekly questionnaires (self-reporting) about their sauna weekly frequencies.

Most participants (1500) reported visiting the sauna two or three times weekly; six-hundred visiting once a week; with two hundred frequenting the sauna four to seven times weekly. 12 never used the the steam room at all.

According to the study, once-a-week visitors when compared with daily (seven times a week group) were more likely to die from sudden cardiac arrest (SCA), heart disease (HD) and cardiovascular disease (CVD). When both groups of visitors were compared, the study found that in the latter cohort, the risk of dying from SCA, HD and CVD was 63 per cent lower when compared with the former group. Some of the baseline indicators included good pressure, electrocardiogram, cholesterol, C-reactive protein, smoking, alcohol use and frequency of exercise. In its findings, the researchers concluded that frequency and duration of stay were inversely correlated to lower risks of sudden cardiac death, fatal coronary heart disease, and fatal cardiovascular disease over the 20-year period of time.; suggesting that frequent and long sauna durations were beneficial to our hearts. This association remained unchanged even after certain confounding variables were controlled.

According to the study, in 2011, the team retrospectively reviewed hospital documents including death certificates and autopsy reports to assess participant cause of death.

Mortality and cause of death Percentage of Sauna Study Participants in Finland
Source: Study Data


According to available data on all mortality (1807 cases) distribution collected and reported retrospectively, the graph illustrates that the percentages of mortality among sauna cohort participants were 10%, 16%,22% and 52% in the SCA, CD, CVD and other respectively.

Finally, with regard to sudden cardia death the research team reported that ten percent of the once-a-week sauna users died; eight percent of those who used the sauna two or three times weekly and five percent of those who went four to seven times per week also died.

So, is it time to check out our well-maintained and managed sauna in the club house? Your call, check it out!

U. of West Indies M and E Plan Workshop


M and E Plan Pre-Test Answers

CORRECT ANSWERS: 1 B; 2 A; 3 A; 4 A; 5 B; 6 B; 7 A; 8 A; 9 B; 10 A


Health Benefits of Nature: A non-Prescription Elixir


Are Naturalists made or born?


When I was growing up, I had the opportunity to go to a public elementary school and unlike many such institutions, my school had a farm – orchard with fruits, and even a ranch! I spent most of my free time there hanging out with my friends. We all had the chance to escape from the parental demands, had our hide and seek events and above all, enjoyed the garden.


During this period, pupils in this school, after a certain age, were qualified to take the cattle out for grazing: an event that permitted us to go up the hills with our cattle. When it was my turn, I often had sleepless nights the day before. Couldn’t wait to be out there!


After high school, I also had opportunities to advance my education in several fields. I chose to take a course as a survey technician; again another opportunity to be outside. This was indeed one-in-a-lifetime experience and even up till this day, I continue to miss that experience.


A few days ago, i was chatting with Dave, one of my neighbors. During this conversation, one issue that came up was the CVE, its uniqueness and ecosystem. We are both impressed (and I’m sure others too) by the ingenuity and vision of the designers of this village. The ecosystem – birds, trees (storm damage notwithstanding), the creeks, etc. have collectively provided us with a “natural” habitat that gives many of us sun birds a compelling reason to head down south during the unfavorable weather conditions up north. In fact in Quebec, studies have confirmed that heart attacks, especially while shoveling during snowstorms, are more prevalent during the winter season!


And the urge for nature and its benefits is not only limited to these cases. For example (a case I know best) in Canada, where many people own and believe in their cottages, scramming when possible to the country side is quite common. Try to visit someone in Ontario during the summer months. They are all in their hideouts or cottages as we call them. What is the motivation? A love for nature and an opportunity to escape from the inner cities and their rat-rushes! I’m sure the same obsession applies to many US cities too. Last year, I had an opportunity to visit Yosemite, Grand Canyon, Rushmore, Joshua and Death Valley National Parks. The crowds in many of these parks were compelling evidence of how we appreciate the importance and benefits of exploring the wilderness!


Nature is our best friend. As little as 10 minutes in the woods can refresh us, increase cortisol levels and release tension and stress hormones. Researchers in England show that green spaces help reduce mental health disparities that arise from problems at work. Here we have provided at least two instances when nature “made me feel better”, one was during the school’s farm sessions and the other during my occasional escapades with friends to the cottage in Canadian summers.


I am a huge fan of walking outdoors and getting all of the Vitamin D possible. I am also a nature lover, I believe in the benefits to the human body, mind and soul. Maybe it’s the way the woods smell, or the wind as it caresses my neck and uplifts my spirits. Or, maybe it is just the fact that I feel free as I roam through and touch the trees, smell the roses, and embrace the beauty of nature.


The breeze is my favorite, especially when it’s warm and calm. The water waves are also beautiful as they hit each other, make splash and leave in awe at how beautiful they are. The smell of the beach is mesmerizing and the sight of a beautiful sunset is calming. I believe that nature can really help us heal, restore our energy, provide us with some motivation, relieve our stress, and make us happy.


In a NY Times book review of “The Nature Fix: Why Nature Makes us Happier, Healthier and More Creative”, by Florence Williams March 5, 2017, Jason Mark outlined the author’s analysis of how researchers in England have demonstrated the benefits of nature including improved learning abilities, mitigating financial health disparities etc.

Details of the review are available on: https://www.nytimes.com/2017/03/02/books/review/nature-fix-florence-williams.html?_r=0


And to those naturalists (made or born) keep up the efforts!


Bongs Lainjo










Is procrastination the steal of time?


According to Cambridge English Dictionary, Procrastination is the avoidance of doing a task, which needs to be accomplished.

It is the practice of doing more pleasurable things in place of less pleasurable ones, or carrying out less urgent tasks instead of more urgent ones, thus putting off impending tasks to a later time. Sometimes, procrastination takes place until the “last minute” before a deadline. People may procrastinate personal issues (raising a stressful issue with a partner), health issues (seeing a doctor or dentist), home care issues (patching a leak in a roof), or academic/work obligations (completing a report).

Although procrastination may or may not be what one wishes to do, it may actually be a choice that comes from the innate need of a person to complete things at the last minute. Sometimes people are unable to work properly unless they are forced to do so by time, family or management. There are other types of people who may feel like pressure is not the way to handle tasks and may become overwhelmed with feelings of guilt, inadequacy, depression and self-doubt. If you are someone who feels negative emotions as a result of leaving things to the last minute, then there are some suggestions we can make to help you be at ease and procrastinate less.

Before we delve into those suggestions, I personally have a tendency of starting something with a lot of zeal, motivation and excitement. And of a sudden, all that thinking just simply disappears and I then begin to run out of ideas and ultimately push it on the side and in some circumstances forget until in a similar way things and other ideas start to manifest themselves followed by another level of euphoria. For example, I started the first draft of this article in February of 2016 and have only recently able to put it all together. In a sense, I view procrastination as an inspiration of a creative mind! And quite often, I develop innovative ideas, then let them “die”; until one day either during a walk in the “wilderness” or reading in the library, the idea gradually starts to materialize and sooner than later I “grab the bull by the horn” and the rest is history! And before I forget, something that I must confess that I do quite often and which tends to enhance my level of productivity is “multi task”: a topic for the next time

The following are two recommendations from an expert that will help you if you find yourself procrastinating often and face challenges getting back on track, sometimes the simplest formulas will do the job.

The first recommendation would be to plan ahead. Planning can be a daunting task in itself, however, through organization comes clarity and ease. There is more to this, however. Because procrastinators seem to love planning, there is also a need to pursue the tasks consciously (www.waitbutwhy.com). Because planning has nothing to do with doing, the procrastinator needs to plan at the macro and micro level. In this sense, the plan will involve larger tasks and smaller, inclusive tasks that need to be accomplished in order for the macro tasks to be completed. Thus, the plan will have a big list and a small list where micro-activities are noted as being pertinent to completing the bigger tasks. For instance, let us say you have a doctor’s appointment and this is the second time to scheduled it. It would be easy to dismiss it as unimportant and to re-schedule it again, especially when there are no serious medical conditions. However, by simply attending that appointment, the stressor of having to re-schedule it, remember that there is an appointment and then having to go to the appointment is eliminated. By jotting down small reminders of what to do the night before (i.e., going to bed early), the morning of the appointment (i.e., leave an hour earlier to avoid traffic), and the day of (i.e., ask doctor about blood pressure), you will be able to accomplish the big task: attending the appointment. It is a matter of saving time, stress and resources by facing the task head-on and not letting it continue to be a part of your life.

The next suggestion is to prepare to get DOING. Doing is where the magic happens. Staring at the plan, big and small list, will not do anything for you but remind you that there are things that need to be done. Doing refers to starting with the first ticket on the small list. This also means that the scheduling needs to be respected as though it was a commandment. If the micro activities get done, you are well on your way to completing the actual project and finalize it with ease and grace. Encouragement and motivation to do this comes from seeing the big price and the light at the end of the tunnel. Reminders serve well for this and should be noted all over your desk area in order to remember why procrastinating is not an option.

In sum, it is important to get things done when they need to be done and not procrastinate. This saves us time, effort and stress in the future. By not getting them done on time, we actually end up doing more than we are supposed because of all of the stress associated with re-planning those activities. By DOING, the stress becomes much less and only increases when finishing up the task at hand, which is very short-lived. Besides a little adrenaline rush is good for the soul. For instance, once the appointment with the doctor is over, you will be able to forget about it and move on with your other life duties. Stress is removed by DOING. Remember procrastinating could lead to emotional and psychological difficulties with increased feelings of guilt and depression. It is better to get the task done and move on, better than storing it in the back of your mind while you figure out how you will get it done next time around. Thinking about it is not DOING it. Plan it, get it done and leave the stress behind.



Bongs lainjo