Impact of digital health records on public health: Barriers to takeup and impacts on managerial efficiency

This project ultimately seeks to study the impact of hospital management information systems (HMIS) on managerial efficiency at the hospital ward level in Myanmar. Myanmar, like many developing countries, manages hospitals almost exclusively with paper-based records. Introducing an HMIS adapted to a constrained resource setting has the potential to greatly streamline hospital operations, and improve ward-level performance by allowing medical staff to make more accurate diagnoses through access to a patient’s entire medical record. The HMIS has been developed by Koe Koe Tech, a social enterprise based in Yangon, Myanmar. This project has the potential to serve as proof-of-concept for using hospital management information systems (HMIS) to improve health outcomes in Myanmar and beyond. More broadly, this project will also explore the role of digital solutions in improving managerial performance and productivity, particularly in public institutions.

As a precursor to studying the impact of HMIS across a large sample of hospital wards, we seek to initiate a study that will assess barriers to uptake of HMIS. While the system has potential to greatly improve hospital efficiency and the satisfaction of medical staff and patients in the long run, as with any disruptive technology it can be expected that there will be frictions to uptake and optimal use. In particular, we expect that busy and overworked hospital staff may initially be resistant to uptake of the system, if they are expected to internalize all learning and adoption costs on their own. Hence we seek to explore ways in which up front incentives can be used to more effectively help medical staff coordinate in quickly taking up the new technology. While relevant in a practical sense, this work, inspired by Atkin et al (2014)’s study of soccer ball producers in Pakistan, speaks to a much broader literature on the barriers to technology adoption, here adapted to large, public institutions.

This study will initially involve qualitative work that we hope to build into a randomized control trial comparing the most promising incentive treatments to induce uptake of the new technology. Along the way we hope to continue building towards a large-scale randomized control trial study that can assess the impacts of HMIS at the hospital ward level.

Health is one of the core pillars of economic development, enabling workers to perform at their full potential, stimulating optimal development of human capital, and reducing losses arising from health shocks. Moreover, it is well documented that productivity is lower in developing countries, and a major potential obstacle to economic growth across developing countries is the lack of adoption of productivity-enhancing technologies. A key factor driving this may be the resistance of public sector workers to adopting new practices and technologies.

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