The implementation of Electronic Medical Records System EQUALI to Improve Patient Care

Received Mar 15, 2021 Revised Apr 06, 2021 Accepted Apr 27, 2021 In the present article, where we live a pandemic because of Covid-19, it presents a challenge and a change in the way we live for all, in which a different way of being able to receive medical care must be created. in this research aims to implement the electronic system of medical records to improve patient care, such research is descriptive-explanatory showing a population of 67 patients from a health center, those who were evaluated by the Z-test, the time-to-date measurement of medical appointments and the instrument of patient satisfaction with respect to the time of care that were created and validated by expert trials, obtaining a Cronbach Alpha of 0.894. As results it was obtained Z s 33.67 > greater than 1.96 for the first variable and Zc-2.0742 > 1.96 respectively. In conclusion, the implementation of the Electronic Medical Records System improved patient administrative care at the Health Center.


INTRODUCTION
Today, the world has found the need to acleratedly implement technological tools even more in the pandemic context in which people experience fear of contracting COVID-19 [1] [2], in Peru, public policies have been implemented to counteract this disease, for example: in education using new forms of education [3] [4] through the use of ICTs, in health through the use of telemedicine, telequeries and electronic clinical history systems (EQUALI). Achieving acutilaity to have 65.3% of health centers and positions integrated into this system, as a plan of the concept of improvement of patient care [5].
The health center located in the district of San Miguel has some problems manipulating and administering the information of patients who are treated in said nosocomio since they do not have adequate technologies for the management of data in a systemic (ordered) way [6], such information of patients has different addresses of domicile, there is duplicity in medical records, and are archived manually which makes it vulnerable to any loss of information about patients (customers). So, it is necessary to implement an electronic medical records system as part of a process of improvement to a digital health of effectiveness and quality, where the beneficiary is the patient and the workers.
This article discusses the influence of the implementation of the sun electronic medical records system to improve patient care, which will improve administrative processes and in the administration of  [9]. Allowing users to no longer queue from very early hours which generates entropies in the organization. Allthis analysis will be measured by a stately analysis to users in their delay times from the time they take out their medical appointments until they are taken care of.

RESEARCH METHOD
The research method that was used to study the health center was the scientific method, this as they are those that can be objectively tested, based on general laws and theories; be subject to measurements, as they are essentially based on quantitative terms or methods for verification.
The application of the general method leads to a systematic series of procedures, using and applying scientific research for the observation of knowledge extensions. We came up with the idea that the scientific method is like organization, and the framework where consistently related rules and principles were formed.

SPECIFIC METHOD 2.1.1. OBSERVATION METHOD
This method will allow us in the research to possess the content of being able to point out and manifest the procedure, having obtained appropriate and complete data that are appropriate to the behavior, event and / or realities fully recognized and inserted in the theoretical context.  Figure 1; this method of observation has as phases the following: • What can be observed? • At what time and/or to whom to observe?
• What should it be observed with?
• Where should it be observed?
• Data collection and optimization.
• Interpretation of the results obtained.

LEVEL OF RESEARCH
The level of research that was applied was the explanatory one, as it allows to treat the problem directly in relation to its causes and effects that arise in its development, Describes and  11 measures the relationship where the cause is the implementation of a system of electronic medical records and the effect on improving patient care.

RESEARCH TYPE
It wasexplanatory. Because it seeks the application or use of the acquired knowledge, while acquiring others, after implementing and systematizing the practice based on research. By solving a problem through the implementation of a Clinical History System and thus improving patient care in the Health Center, the level of research applied here was the explanatory one, as it allows to treat the problem directly in relation to its causes and effects that arise in its development, describes and measures the relationship where the cause is the implementation of a medical history system and the effect on patient care. The possible solution that arises in the hypothesis.

= 1 × 2
: Admission service workers, as well as patients requesting appointments. all of them of legal age 1 : The health center's admission service prior to the implementation of the electronic medical records system × : The implementation of the electronic medical records system 2 : Thealth center admission service after implementation of electronic medical records system The design of this research is experimental because statistical management of the collected information is carried out and the situation is controlled at all times, and it is also of the preexperimental type, since only the independent variable is handled with pre-and subsequent testing. The research did not use a sampling technique because it is a small population, therefore the census technique was used, with a total of 67 people

DATA COLLECTION TECHNIQUES AND INSTRUMENTS, VALIDITY AND RELIABILITY Techniques:
The field research technique is the survey. It is a popular research technique because it allows data collection through questionnaires spread among the elements of a given population and is usually used to obtain reliable data about the attitudes, opinions and behaviors of individuals [10].

Instruments:
The instrument is the questionnaire. is a methodological means used to collect information from primary sources of research, in addition to being consistent with the approach, level and design of the research used. Validity: Validity refers to the effectiveness with which an instrument could collect the attribute or quality of what is being measured [11]. This thesis chose to find out the validity of its instruments through the validity of experts associated with the validity of content [12]. Reliability: Reliability is measured in terms of stability and internal consistency of the research instrument [13]. As a result of a mathematical measurement, the coefficients obtained with the Cronbach alpha are recorded: Instrument for relational variable: 0.894

RESULTS AND DISCUSSION
The "z" test has been used for the hypothesis test. The analyses were also carried out in accordance with the design of the research. With the pre-test and post-test, in order tobe able to contrast the hypotheses and thus be able to perform the acceptance or rejection of the hypotheses raised in this investigation. The results obtained are presented below.

STATISTICAL ANALYSIS 3.1.1. AVERAGE APPOINTMENTDELIVERY TIME Clarification of variables:
TPECa -Average appointment delivery time with the current system. TPECp -Average appointment delivery time with the proposed system.

The Statistical Hypothesis
The hypothesis Ho=Average time in the delivery of appointments with the existing application is less than or equal to the average appointment delivery with the proposed application.   Table 2 shows that the average delivery time of medical supplies with the current application (Ta) deducting the average delivery time of the inputs using the proposed application (Tp) results in a decrease in the delivery time of medical supplies with support of the application under construction where it offers us a favorable percentage.
The average appointment delivery time was reduced by 64.91%, in whose hypothesis test applying to a sample of 67 medical appointments, a Z was obtained by 33.67, the higher being the value of 1.96 with a significance level of 95%, this value being found in the rejection zone of Ho, accepting the Ha.
This then leads to the average time of the process of transmissions of medical care appointments creating longer than the average time of care in the deliveries of health care appointments with proposed electronic medical history system, arriving at this one, which is within the research at a level of significance with a value of 5% with a level of confidence with a value of 95%. Therefore, it can be evaluated that the average time in deliveries of health care appointments with the current application reaches a time of 54.15 minutes with an average time in deliveries of medical supplies with the proposed Application in a time of 19 minutes, and this represents a decrease in time of 35.15 minutes. Calculating the value of the "Z":    Figure 4 shows that 61% corresponds to the "SI" dimension of the post-test compared to 44% of the previous "SI" test. Evidence of a 17% improvement in patient satisfaction with respect to care time with the use of the proposed system. This research shows a 17% improvement in patient satisfaction with respect to attention time with the use of the proposed system post, this is evidenced by obtaining 61% in SI dimension 51 in the post-test, thus improving the SI value of the pre-test where 44% was obtained.

PATIENT SATISFACTION WITH RESPECT TO CARE TIME
Concluding that the Ho hypothesis is rejected and Ha is accepted, then it is confirmed that the implementation of the system influences patient satisfaction as far as care time is concerned. What was checked with an error level of 0.5% (0.05), resulting in the execution of the proposed application as one of the most optimal solution alternatives for solving the research problem raisedµ 2. With the existing application the level of Patient Satisfaction with respect to the time of care in the health center has with the proposed application a satisfaction of 61% thus improving by 17% compared to the initial situation where a level of satisfaction of 44% was obtained, this improvement is due to the patient and the administrative staff who have been adapting to the use of the proposed system. So similar was it in the implementation carried out in a northern health network [15].
3. Finally, after having obtained satisfactory results from the indicators of studies, it is concluded that the research that was received has optimized the administrative care of patients of the San Miguel Health Center, this by implementing an application of electronic medical records.