Personnel
To develop and maintain an EMR system, staffing is extremely important.
We have found that support staff are needed for two basic functions:
At least 1 technician for 40 computers at up to 5 project sites is needed to support networking and hardware and to provide user support.
Data managers
At PIH sites, the data manager is responsible for providing a daily schedule, managing team expectations/priorities and data quality. The manager assesses data quality by carrying out regular data accuracy evaluations on randomly-chosen patient sets. Quality checks also help to detect systematic data errors, such as entering the wrong date from a form. We have found that more than 4 months of on-the-job-training is needed before data accuracy can be assured.
Data clerks
One data clerk is needed for every 300-400 patient records; we recommend that a minimum of 2 data clerks be kept on staff at all times. Once a team of 4 or more data clerks is established, a data entry manager is usually necessary. Hiring and training data clerks before the system is fully operational is helpful as it will prevent a backlog of patient data and decrease long term pressure on the staff.
Hiring and training of data clerks
As accurate data entry is critical to ensure appropriate clinical treatment of patients, the hiring and training of data clerks is particularly important. Candidates are interviewed and evaluated for problem-solving abilities, attention to detail and enthusiasm. They are then asked to type a short paragraph in the local languages, to reproduce data on an Excel spreadsheet with the correct formatting and tested on their familiarity with the Internet and web navigation.
Their training is phased in order of difficulty and to allow for understanding of the different parts of the system before moving to the next level. The clerks first begin with patient creation and form entry, then to changing data, advanced patient editing, cohort building and report printing and finally, data export and producing daily reports. Regular data quality tests are performed at least once a month.
Additional training sessions
Ongoing and regular training sessions for data clerks are also important to share questions, review difficult procedures or learn new functionalities. Data managers should also ensure that the care providers and other staff at the site are comfortable with the data collection process using the EMR so they can take advantage of the capabilities of the system. Developing a demonstration video can illustrate the EMR’s uses and help them understand the ways EMR can benefit their work.
Supervising a data team
Easy communication between data managers and team members is essential. While constant on-site supervision of team members is impossible when data clerks are spread out among multiple project sites, the data manager needs to be able to contact other team members at any time.
In PIH’s sites in Rwanda, the data manager uses a cell phone system, where all members of the team are given a monthly phone allowance to call or text the data manager and each other. These cell phone privileges not only facilitate communication between team members, they also encourage good work practices. Online communication is also an important way to maintain momentum and keep team members up-to-date. Again in Rwanda, the current data manager is available to team members through use of online chat programs.
- Add new functionalities and repair errors within the system:
an experienced software programmer (usually off-site) is required. At
PIH a half-time programmer is sufficient for a system with about 100
users. However, while the system was in development, PIH employed a
full time programmer.
- Provide direct user support (help with logins or system access): this is generally done by the on-site IT Technician.
In addition, the following positions are essential at project sites:
IT technicians
IT technicians
At least 1 technician for 40 computers at up to 5 project sites is needed to support networking and hardware and to provide user support.
Data managers
At PIH sites, the data manager is responsible for providing a daily schedule, managing team expectations/priorities and data quality. The manager assesses data quality by carrying out regular data accuracy evaluations on randomly-chosen patient sets. Quality checks also help to detect systematic data errors, such as entering the wrong date from a form. We have found that more than 4 months of on-the-job-training is needed before data accuracy can be assured.
Data clerks
One data clerk is needed for every 300-400 patient records; we recommend that a minimum of 2 data clerks be kept on staff at all times. Once a team of 4 or more data clerks is established, a data entry manager is usually necessary. Hiring and training data clerks before the system is fully operational is helpful as it will prevent a backlog of patient data and decrease long term pressure on the staff.
Hiring and training of data clerks
As accurate data entry is critical to ensure appropriate clinical treatment of patients, the hiring and training of data clerks is particularly important. Candidates are interviewed and evaluated for problem-solving abilities, attention to detail and enthusiasm. They are then asked to type a short paragraph in the local languages, to reproduce data on an Excel spreadsheet with the correct formatting and tested on their familiarity with the Internet and web navigation.
Their training is phased in order of difficulty and to allow for understanding of the different parts of the system before moving to the next level. The clerks first begin with patient creation and form entry, then to changing data, advanced patient editing, cohort building and report printing and finally, data export and producing daily reports. Regular data quality tests are performed at least once a month.
Additional training sessions
Ongoing and regular training sessions for data clerks are also important to share questions, review difficult procedures or learn new functionalities. Data managers should also ensure that the care providers and other staff at the site are comfortable with the data collection process using the EMR so they can take advantage of the capabilities of the system. Developing a demonstration video can illustrate the EMR’s uses and help them understand the ways EMR can benefit their work.
Supervising a data team
Easy communication between data managers and team members is essential. While constant on-site supervision of team members is impossible when data clerks are spread out among multiple project sites, the data manager needs to be able to contact other team members at any time.
In PIH’s sites in Rwanda, the data manager uses a cell phone system, where all members of the team are given a monthly phone allowance to call or text the data manager and each other. These cell phone privileges not only facilitate communication between team members, they also encourage good work practices. Online communication is also an important way to maintain momentum and keep team members up-to-date. Again in Rwanda, the current data manager is available to team members through use of online chat programs.
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